Reduction techniques

Question 1

Anterior AC dislocation

Answer 1

place patient supine with arm at edge of table
abductandextendarm while applyingaxial traction and direct pressure
simultaneously applydirect posterior pressureover medial clavicle

Question 2

Subtalar dislocation

Answer 2

• Knee flexion to relax Achilles
• Ankle PF and Traction + Hindfoot eversion (medial) or inversion (lateral)
• Post-reduction CT for associated fracture

Question 3

ankle dislocation

Answer 3

• Knee flexion, ankle DF (should reduce)
• Hold anterior tibial pressure to keep reduced while casting
• Split cast

Question 4

knee dislocation

Answer 4

• Dependent on direction of dislocation
• Traction on femur, reverse MOI
• Splint in 30 deg flexion
• Ex-Fix if residual subluxation or inability to maintain reduction

Question 5

hip fracture - leadbetter

Answer 5

• Patient on flattop
• Flexion to 90, slight abduction and traction/IR to 45
• Maintain IR, extension/adduction

Question 6

anterior hip dislocation

Answer 6

• In line traction
• Lateral translation
• ER to get over anterior wall, IR into joint

Question 7

posterior hip dislocation

Answer 7

• Allis Maneuvre
  o Flex knee to relax hamstrings
  o Traction with slight hip flexion, counter-traction on pelvis
  • Traction in line with deformity
  o Adduction/IR to disengage
  o Slight ER → clunk
• Always assess stability post reduction
• Knee immobilizer and Post op CT for associated factures, concentric reduction

always have a careful look at the XR to make sure it’s concentric, there may be a small piece of the posterior wall in the joint

if the femur is fractured you can put a schnoz pin threw the vastus tubercle into the neck to get your reduction

Question 8

posterior shoulder dislocation

Answer 8

• Traction counter traction
• Manual manipulation of head to disengage
• When feels disengaged, gentle ER to reduce
• Immobilize in ER, CT for bone loss

Question 9

Elbow dislocation

Answer 9

sedation from anesthesia for airway and meds
gentle in line traction with supination and flexion
pressure on the tip of the olecranon
assess under anesthesia for stability, splint in pronation or sup nation if only unstable 60 then consider OR, otherwise split with hinged brace and progressive extension block, PT for early flexion/extension and only sup/pro at neutral