Reducing Dislocations

The techniques used to reduce specific dislocations are discussed in subsequent chapters. In general, prereduction x-rays are advisable unless circulation is threatened and prompt radiologic evaluation is not available. X-rays are needed because dislocations and fracture-dislocations may have the same clinical appearance on physical examination, but the techniques used to treat them may be markedly different. An example is simple anterior dislocation of the shoulder, as opposed to the same injury associated with complete fracture through the humeral neck. If the fracture is identified at the outset, the patient will be spared the pain of prolonged unsuccessful reduction attempts, and no question will arise as to exactly when the fracture might have occurred. Even "pure" dislocations may be associated with minute fracture fragments. A prereduction film will usually furnish proof of the preexistence of such fragments.

Of course, there are circumstances in which the potential benefits of a prereduction film may be outweighed by the associated expenditure of time and money. For example, a prereduction film may be omitted in a patient with a history of multiple recurrent dislocations of the shoulder, who presents with history, signs, and symptoms typical of another recurrence.

The importance of postreduction films is another consideration. Occasionally a joint may feel as though it has been reduced, when in fact it has not. Even when a maneuver is successful, the joint may redislocate after the patient leaves the emergency department. There is no way to prove that the joint was in anatomic position at the time of discharge, without a postreduction film. The obtaining of postreduction films is, of course, a matter of judgment and ultimately at the clinician's discretion.

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