Most dislocated joints can be treated in a closed fashion with intravenous analgesia and sedation. Occasionally, patients must be taken to the operating room for general anesthesia to aid in reduction and may have to have open reduction if that fails. Care must be taken in relocation, as certain maneuvers are associated with high risks of fracture.

Once relocated, range of motion in the joint should be tested to assess for stability and possible ligamentous damage. The neurovascular status distal to the joint should be reevaluated. CT scan is frequently obtained in cases of fracture dislocation to assess articular fragments and joint congruity. MRI is beneficial to assess surrounding soft tissues and structural supports. Finally, an arteriogram may be required to assess vascular status.

Selected Reading

1. Browner BD, Jupiter JB, Levine AM et al. Skeletal trauma: Fractures, dislocations, ligamentous injuries. 2nd ed. Philadelphia: W.B. Saunders Company, 1998:1.

2. Kushwaha VP, Garland DG. Extremity fractures in the patient with a traumatic brain injury. J Am Acad Orthop Surg 1998; 6:298-307.

3. Canale TS. Campbell's operative orthopaedics. 9th ed. St. Louis: Mosby, 1998:3.

4. Burgess AR, Eastridge BJ, Young JWR. Pelvic ring disruptions: Effective classification system and treatment protocols. J Trauma 1990; 30:848-856.

5. Turen CH, Dube MA, LeCroy CM. Approach to the polytraumatized patient with musculoskeletal injuries. J Am Acad Orthop Surg 1999; 7:154-165.

6. Gustilo RB, Merkow RL, Templeman D. The management of open fractures. JBJS 1990; 72-A(2):299-304.

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