dislocations (such as those of the jaw, finger, orshoulder) if there is no arterial or nerve involvement(pulse will be palpable and there will be no numbnessbelow the joint). Treat all other dislocations asfractures, and evacuate the victim to a definitive carefacility.DISLOCATION OF THE JAW.—When thelower jaw is dislocated, the victim cannot speak orclose the mouth. Dislocation of the jaw is usuallycaused by a blow to the mouth; sometimes it is causedby yawning or laughing. This type of dislocation is notalways easy to reduce, and there is considerable dangerthat the operator’s thumbs will be bitten in the process.For your own protection, wrap your thumbs with ahandkerchief or bandage. While facing the victim,press your thumbs down just behind the last lowermolars and, at the same time, lift the chin up with yourfingers. The jaw should snap into place at once. Youwill have to remove your thumbs quickly to avoidbeing bitten. No further treatment is required, but youshould warn the victim to keep the mouth closed asmuch as possible during the next few hours. Figure4-45 shows the position you must assume to reduce adislocated jaw.DISLOCATION OF THE FINGER.—Thejoints of the finger are particularly susceptible toinjury, and even minor injuries may result in prolongedloss of function. Great care must be used in treatingany injury of the finger.To reduce a dislocation of the finger, grasp thefinger firmly and apply a steady pull in the same line asthe deformity. If it does not slip into position, try itagain, but if it does not go into position on the thirdattempt, DO NOT TRY AGAIN. In any case, andwhether or not the dislocation is reduced, the fingershould be strapped, slightly flexed, with an aluminumsplint or with a roller gauze bandage over a tongueblade. Figure 4-46 shows how a dislocated finger canbe immobilized by strapping it to a flat, wooden stick,such as a tongue depressor.DISLOCATION OF THE SHOULDER.—Before reduction, place the victim in a supine position.After putting the heel of your foot in the victim’sarmpit, grasp the wrist and apply steady traction bypulling gently and increasing resistance gradually.Pull the arm in the same line as it is found. Afterseveral minutes of steady pull, flex the victim’s elbowslightly. Grasp the arm below the elbow, apply tractionfrom the point of the elbow, and gently rotate the arminto the external or outward position. If three reductionattempts fail, carry the forearm across the chest andapply a sling and swathe. An alternate methodinvolves having the patient lie face down on anexamining table with the injured arm hanging over theside. Apply prolonged, firm, gentle traction at thewrist with gentle external rotation. A water bucketwith a padded handle placed in the crook of thepatient’s elbow may be substituted. Gradually addsand or water to the bucket to increase traction.Grasping the wrist and using the elbow as a pivot point,gently rotate the arm into the external position.SprainsSprains are injuries to the ligaments and softtissues that support a joint. A sprain is caused by theviolent wrenching or twisting of the joint beyond itsnormal limits of movement and usually involves amomentary dislocation, with the bone slipping backinto place of its own accord. Although any joint may4-55Figure 4-45.—Position for reducing a dislocated jaw.Figure 4-46.—Immobilizing a dislocated finger.
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