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Mountain First-aid and Medicine

Dislocations

Dislocations occur when a bone gets out of its articulation (luxation) and stays in a dislocated position. Serious traumatic luxations provoke, additionally, tendon rupture and blood vessels or cartilage lesions. During excursions, the most common luxation is the painful shoulder dislocation. While descending 6 000 m mount Marmolejo one of our participants skidded on a snow field and dislocated a shoulder as he tried to stop from falling. Because he didn’t have any other lesions, we proceeded to apply the shoulder reduction maneuver. The arm was immobilized with a sling for a few days and, later on, the participant even ascended the almost 7 000 m mount Aconcagua. If kneecaps, shoulders or finger articulations are not reduced as soon as possible, permanent damage can occur, due to the strangled nerves or blood vessels. Luxations of the toes are rare during excursions because of the good protection offered by hiking shoes. In principle, dislocations and fractures must be first treated and then immobilized.

Measures

Dislocations provoke cramps and swelling of the surrounding muscles. If there are no other lesions, (tendon rupture, fractures) except for the luxation itself and if, in addition, no dangerous nerve or blood vessels strangulation exist, then the articulation must be put back in its normal place as soon as possible.

 

Shoulder dislocation

  • The affected person must lie down on a pad or mattress.
  • Take the person’s wrist firmly with a hand. With the other hand take the injured person’s arm just under the elbow. Tense his or her arm by pulling it steadily in a direction opposite the body. This movement brings about the relaxing of the muscles.
  • Flex the person’s arm at the elbow putting it in a vertical upward position. At the same time, the rescuer hand holding the elbow continues to pull the injured person’s arm in a direction opposite the body.
  • The patient’s flexed arm must be put slowly on the floor directed towards the head, without stopping pulling the arm. Remain in that position, continuously pulling the arm, for about 10-25 minutes.
  • If after this period of time you notice a clear sign of muscle relaxation, then tha arm has to be moved downwards, as if the affected person was going to throw a ball.
  • The reduced arm must be immobilized in a sling for several days and be controlled by a doctor at the first occasion.

Shoulder dislocation

Kneecap dislocation

  • The affected person lies on the floor with the legs folded. The rescuer takes in each hand the thigh and calf of the person and slowly stretches the leg entirely.
  • If the kneecap doesn’t automatically jump backwards, it must be pushed a little with the fingers until snap it in place.
  • With a support bandage in the knee, the person may be transported, despite the pain.

Finger dislocation

Finger dislocations are caused, during excursions, by serious falls and often are accompanied by fractures. In these cases, the affected finger is twisted in a strange way in relation to the hand.

  • The dislocated finger must be taken over the luxated articulation, while the other hand of the rescuer holds the affected person’s hand.
  • First, the finger is pulled in the direction where it points, opposite the hand.
  • Now, the finger can be put into the right position, without stopping the pulling.
  • The affected finger must be splinted and the patient brought to a doctor.

Kneecap dislocation

 
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