*Reducing a Dislocated Kneecap*
Field Reduction of Patellar Dislocations

By: MountainMedic
21 May 2007

I am pretty conservative about giving medical advice and usually advise people to call 911, go to the ER or talk to their doctor. But what if a doctor or 911 service is not available either because you are days into the wilderness or the local EMS system has been over whelmed by a disaster? Some injuries such as a dislocated kneecap, also known as the patella, can be debilitating until they are fixed, but are easily fixed. When your patella is dislocated you will not be able to walk and will be in rather severe pain. Although not a life threatening injury by itself there are circumstances where a dislocated patella could be deadly. What if the dislocation happened as you were hurrying down a mountainside to get down before a cold front came in. Or maybe it happened in your rush to gather together a few final items before bugging out because of a coming hurricane. As soon as it is back in place the pain will be reduced dramatically and in most cases you will again be able to use your leg again.

Again, This is for INFORMATION purposes ONLY... Reading an article in the Internet does NOT make you a Medical professional, and should NOT be considered a substitute for proper Medical care! ALWAYS seek proper Medical attention if AT ALL possible!!!!

As a paramedic I loved having patients with dislocated patellas. They are easy to diagnose, easy to fix and the patient usually thought I was a hero because with in a few minutes of arriving at their side I could have them almost pain free. Many EMS systems will not allow a paramedic to reduce a dislocation. I think this is a disservice. The longer a dislocation is allowed to remain out of place the harder it is to get it back. A combination of swelling and the muscles tightening up around the dislocation clamping the dislocated part into its new position contribute to the increased difficulty. Even on a normal day in most emergency departments some one brought in with a dislocated patella will have to wait quite awhile before seeing a doctor and getting the problem fixed. The reason is that despite the pain there is nothing life threatening about the injury. Anyone with chest pain, abdominal pain, SOB, etc. will have to be seen before you. They will take x-rays of the injury and since it now is hurting worse will likely start an IV and give you some medication to dull the pain and make you forget the experience. All of this takes more time.

Diagnosing a dislocated patella is easy. Try playing with your kneecap right now so you will know what a normal one feels like and how it moves. You will notice that if you straighten your leg and are able to relax your leg muscles that your kneecap easily slides back and forth across your knee. You may have to get off your chair and onto the floor to relax your leg muscles. Notice that when you bend your knee you can not slide your patella back and forth anymore. Now imagine what your knee would look like if you slid your patella all the way around to the lateral side of your leg. The front of your knee would be flat and there would be a bump on the side of your knee. That is what a dislocated patella looks like. The flatness of the knee is more difficult to see when the knee is bent but the hump of the displaced patella should still be obvious. Do not let an obvious and painful injury like a dislocated patella distract you from more serious but less obvious injuries such as a possible spinal injury or head injury.

Reducing a dislocated patella is easy. Just straightening the leg (un-bending the knee) will often allow the patella to pop back into place on its own. If not, gently pushing with a fingertip should be enough to push it back into position once the knee is straightened. Since people often think of scenes from the movies where someone gets a dislocation reduced by a violent painful yank I would usually not tell them I was planning on putting the dislocation back. It would make it harder to do since they tighten all their muscles while bracing for the pain they know is coming. Instead tell the patient something along the lines of “We need to slowly straighten your leg. It will be more comfortable once it is straight. If it hurts too much we will stop. Try taking a few deep breaths and relax your leg muscles as much as you can.” Go slow and be ready to stop. Have one hand under the knee supporting it and feeling for crepitus as you straighten the leg. Crepitus is the scraping vibrating sensation you feel when broken bone ends scrape against each other. If you feel crepitus you should stop and splint the leg in the place. It is not the simple dislocation you thought it was if you feel crepitus. While some discomfort is normal, a lot of increasing pain is not and is another reason to stop. Ideally, once the dislocation is reduced the knee should be treated with RICE (Rest, Ice and Ibuprofen, Compression and Elevation). These will keep the swelling down and allow the injury to heal faster. Of course if your life is in danger by staying still, hobble around as comfort allows.

Before and after moving, splinting, reducing or otherwise messing around with any possible dislocation, sprain or fracture it is a good idea to check the distal circulation sensation and movement. This means that you want to check the fingers or toes of the affected limb to make sure they are a normal color and that when a nail bed is pressed it rapidly turns pink again. The affected fingers or toes should feel normal to the patient with out any tingling or numbness and he or she should be able to feel your gentle touch. The patient should also be able to wiggle them normally. The distal circulation, sensation and movement are checked before and afterwards to make sure that nothing was made worse by your treatment. A limb with compromised circulation is an emergency and with out rapid medical care you risk losing the limb. If a limb has good circulation, sensation and movement before you started but does not afterwards you need to try to undo what you did. This does not mean you try to knock the patella out of place again but you should try to loosen any splint or bandage you applied and if that doesn’t work try putting the limb back in the same position as when there was good circulation sensation and movement. If circulation is compromised from the beginning it is likely not a simple dislocation and advanced medical care should be sought if possible but it also makes it more important for you to do something to get circulation back if medical care is not available.

Reducing a dislocated patella is something you should be prepared to do in a disaster situation or when ever medical care is not readily available, but what about other times? Here I can only tell you what I would do. You will have to make your own decisions. If the injured person is a teammate, friend or family member and proper medical care was not available, I would attempt to correct the dislocation. If medical care was available I would try to comfort them while summoning an ambulance. After successfully reducing the dislocation on a friend or family member during an emergency, I would still try to make an appointment to get an x-ray to make sure there were no associated fractures that require any further care.

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