Pediatric emergency medicine trisk 1104

FIGURE 130.35 Closed reduction of joint dislocation. A. Finger/toe. B. Shoulder. C. Patella.
D. Elbow.

Interphalangeal and metacarpophalangeal/metatarsophalangeal dislocations.
Complications
Fracture secondary to attempted reduction.
Interposition of volar plate into joint space during metacarpophalangeal
reductions preventing successful reduction

Procedure
Check the neurovascular status in the affected phalanx. Splint the deformed
phalanx for comfort if necessary. Radiographs are usually obtained to ascertain
the presence of fractures or interposition of the volar plate. It is important to note
that closed reduction of a dislocation may not be possible when there is dorsal
dislocation with interposition of the volar plate or entrapment of the
metacarpal/metatarsal head ( Fig. 130.35A ).
Consider the use of procedural sedation, a digital block, or both. If necessary,
have an assistant restrain the child. Grasp the extremity proximal to the
dislocation to stabilize the joint. Grasp the tip of the distal phalanx and apply
traction longitudinally. The joint will usually slide into proper position. If this
method is unsuccessful, apply pressure distally to accentuate the deformity a few
degrees, that is, mild hyperextension, while applying traction to the phalanx
longitudinally.
After reduction, obtain radiographs to ensure proper position of the joints and
to evaluate for fractures. Immobilize the joint in slight flexion for 2 to 3 weeks in
total, usually with a foam-padded splint. Distal interphalangeal joints are
immobilized in full extension and proximal interphalangeal joints with 20 to 30
degrees of flexion. If a small avulsion of the volar lip of the distal phalanx is

evident, apply a dorsal splint to prevent hyperextension of the affected joint.
In cases in which the reduction is unsuccessful, the volar plate is interposed, or
the second metacarpal bone is trapped, consult an orthopedic /hand surgeon
immediately to assess the need for surgical reduction. Volar dislocations are more
complicated and often require surgical reduction.

Shoulder (Glenohumeral) Joint Dislocation
Indications
Anterior shoulder dislocations. For posterior shoulder dislocations, orthopedic
consultation is recommended.