In-game Management of Common Joint Dislocations

Abstract

Context: Sideline management of sports-related joint dislocations often places the treating medical professional in a challenging position. These injuries frequently require prompt evaluation, diagnosis, reduction, and postreduction management before they can be evaluated at a medical facility. Our objective is to review the mechanism, evaluation, reduction, and postreduction management of sports-related dislocations to the shoulder, elbow, finger, knee, patella, and ankle joints.

Evidence acquisition: A literature review was performed using the PubMed database to evaluate previous and current publications focused on joint dislocations. This review focused on articles published between 1980 and 2013.

Study design: Clinical review.

Level of evidence: Level 4.

Results: The clinician should weigh the benefits and risks of on-field reduction based on their knowledge of the injury and the presence of associated injuries.

Conclusion: When properly evaluated and diagnosed, most sports-related dislocations can be reduced and initially managed at the game.

Keywords: dislocation; joint; reduction; review; sideline; sport.

Figure 1.

(a) The patient is supine with a towel wrapped around his torso. An assistant provides countertraction with the towel while the clinician supports the injured arm and creates traction and gradual abduction until the shoulder reduces. (b) If no assistant is available, the clinician places 1 hand in the patient’s axilla for countertraction and uses the other hand to support the arm and provide gradual abduction.

Figure 2.

(a) Axillary radiograph of the left shoulder demonstrating anterior displacement on the humerus on the glenoid. (b) Postreduction axillary radiograph demonstrating joint congruency.

Figure 3.

Sagittal shoulder computed tomography image demonstrating glenoid fracture after successful field reduction.

Figure 4.

(a) Anterior-posterior radiograph of a left elbow posterolateral dislocation after a fall on an outstretched hand. (b) Lateral image of the same elbow dislocation demonstrating a coronoid fracture.

Figure 5.

The clinician supports the hand or wrist and applies traction and flexion while the other hand is placed on the humerus to provide countertraction. The clinician’s left fingertips are placed over the tip of the dislocated ulna to guide the reduction.

Figure 6.

Anterior-posterior radiograph demonstrating a radial head fracture after successful elbow reduction.

Figure 7.

(a) Lateral radiograph demonstrating that the radial head is not in alignment (white line) with the humeral capitellum. (b) Lateral radiograph of a normal elbow with the radius aligned with the capitellum, as shown by the white line drawn in line with the radius bisecting the capitellum.

Figure 8.

(a) Anterior-posterior radiograph of a left posterior hip dislocation. (b) After proper sedation in the emergency department, the hip was successfully reduced.

Figure 9.

(a) The clinician places his thumb on the tibial tuberosity, as a reference point, with the patella in neutral. (b) He then translates the patella laterally evaluating for apprehension.

Figure 10.

Lateral radiograph of a dislocated ankle without associated fractures.

Figure 11.

Clinician demonstrates hand positions for reduction of an ankle dislocation.