Closed-Reduction Techniques for Glenohumeral-, Patellofemoral-, and Interphalangeal-Joint Dislocations

Abstract

Joint dislocations account for a small but important portion of all athletic injuries, with most occurring at the glenohumeral, patellofemoral, and interphalangeal joints. Athletic trainers are responsible for managing acute joint-dislocation injuries, which may include performing closed-reduction techniques when appropriate. To achieve optimal patient outcomes, the clinician should be formally trained and skilled in performing various techniques and familiar with the evidence supporting the selection of each technique. In this clinical review, we outline general reduction procedures and then summarize and synthesize the existing literature on common closed-reduction techniques for glenohumeral-, patellofemoral-, and interphalangeal-joint dislocations. When appropriate, the content has been adapted to be specific to the athletic trainer's scope of practice.

Practice Patterns of Athletic Trainers Regarding the On-Site Management of Patients With Joint Dislocations

“…One hope we have for this study is that understanding current practice patterns may help shape future training, resources, and research that will in turn affect future clinical practice. One clinical implication of the current findings is to corroborate the results of previous researchers 9 who indicated that ATs considering adding joint reductions to their clinical practice would be well advised to start with the glenohumeral, patellofemoral, and interphalangeal joints. Here, we identified a need to develop closed joint-reduction training and resources (such as sample written standing orders) appropriate for the scope of practice of an AT.…”

“…To our knowledge, no universal consensus exists regarding the types of joint reductions that are appropriate for ATs to perform without direct physician supervision. The 3 types of dislocations we identified as most often performed by ATs were the same 3 that Wright et al 9 indicated were most often deemed acceptable for on-site performance by an AT. This consistency may be due to perceptions of the relatively low risk of performing these 3 reductions (both in relation to legal liability and poor patient outcomes).…”

“…Recommendations regarding appropriate joint-reduction policies typically either contraindicate or strongly caution against performing on-site joint reductions in young children (due to open growth plates) and elderly patients (due to increased stiffness of bones) in the absence of available radiography. 6,9 Our ATs largely complied with those recommendations; only a very small percentage of ATs (2.5%) reported ever reducing a joint dislocation in either of these populations. However, few ATs in this study worked in clinical settings that would include either age group.…”

“…This consistency may be due to perceptions of the relatively low risk of performing these 3 reductions (both in relation to legal liability and poor patient outcomes). 9 The NATA position statement 6 noted that under appropriate circumstances, an AT can reduce or attempt to reduce the following joints: femoroacetabular, tibiofemoral, patellofemoral, metatarsophalangeal, interphalangeal of the fingers and toes, metacarpophalangeal, and glenohumeral. This list includes several reductions that ATs in the current study reported feeling moderately uncomfortable or very uncomfortable performing.…”

“…7 This change marks an important shift in clinical practice for many ATs, but the literature has not caught up. To date, only 3 known articles [7][8][9] addressed the performance of closed joint reductions by ATs. Instead, the broader literature is most commonly targeted at physicians.…”