OR1.4-5 | Common Joint Dislocation Recognition and Reduction Assistance — Summary & Reflection

KEY TAKEAWAYS

Joint dislocations require systematic neurovascular assessment before AND after reduction, correct identification of the anatomical nerve at risk for each joint, and prompt reduction to minimise time-sensitive complications.

Key points:
- Shoulder dislocation: 95% anterior; axillary nerve at risk (surgical neck) — test lateral deltoid sensation (regimental badge) and deltoid contraction
- Posterior shoulder dislocation is missed on AP X-ray — axillary view is mandatory; caused by seizure, electrocution, direct anterior blow
- Hip dislocation: posterior (90%) = limb in flexion/adduction/internal rotation; sciatic/peroneal nerve at risk — foot drop; reduce within 6 hours (AVN risk rises steeply after 12 hours)
- Anterior hip dislocation = limb abducted/externally rotated; femoral nerve/vessels at risk
- Knee dislocation: popliteal artery injury 30–40%; common peroneal nerve 25%; ABI <0.9 = CT angiography mandatory
- Finger PIP dislocation: usually posterior/dorsal; digital block, longitudinal traction, X-ray before and after
- New neurological deficit AFTER reduction = possible nerve entrapment = urgent surgical exploration
- Team member role: countertraction, pelvis stabilisation, neurovascular documentation (pre AND post), procedure note, post-reduction X-ray review

REFLECT

You have observed a closed reduction of an anterior shoulder dislocation in your orthopaedic posting. Afterwards, write a brief procedure note as if you were the assisting doctor. Include: the pre-reduction neurovascular assessment findings, the technique used, the sedation administered, the outcome, and the post-reduction neurovascular assessment. Then ask your registrar to review it. This exercise prepares you for the documentation standard required when you perform these procedures as a house officer. Also reflect: which of the reduction techniques described in this module would be safest to perform without an anaesthetist in a district hospital emergency, and why?