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Fracture dislocation of joint — Clinical Guidelines

Overview

Fracture dislocation of a joint involves a joint dislocation accompanied by a fracture, complicating both diagnosis and treatment. Proper management requires prompt reduction and stabilization to prevent long-term functional impairment 1 3 10.

Diagnosis

Clinical Presentation: Pain, swelling, deformity, and limited range of motion 3.

Imaging: X-rays essential for identifying dislocations and associated fractures 3 10.

Grading: Classification systems vary by joint; complex cases may require MRI for detailed assessment 7 12.

Management

First-Line Treatment: Closed reduction under sedation (e.g., propofol for rapid onset and recovery 4).

Adjunctive Treatments: Open reduction if closed reduction fails due to interposition or complex anatomy 5 9 12.

Immobilization: Post-reduction splinting or casting to maintain alignment 3 13.

Surgical Intervention: Indicated for irreducible dislocations, complex fractures, or failed conservative management 9 10 11.

Special Populations

Pediatrics: Special considerations for growth plate injuries; early reduction crucial to avoid deformity 3.

Elderly: Increased risk of comorbidities; careful assessment and management of associated fractures 10.

Key Recommendations

Prompt Reduction: Achieve reduction as soon as possible to minimize complications (Evidence: Strong 3 10).

Use of Sedation: Employ propofol for sedation during joint reductions to potentially shorten ED stay (Evidence: Moderate 4).

Imaging Confirmation: Utilize X-rays to confirm dislocation and associated fractures before and after reduction (Evidence: Strong 3 10).

Open Reduction When Necessary: Proceed with open reduction if closed reduction fails due to complex anatomical interposition (Evidence: Weak 5 9).

Proper Immobilization: Ensure correct immobilization post-reduction to maintain joint alignment (Evidence: Expert opinion 3 13).

References

1 Lefebvre CW, Hartman ND, Glass C, Daubach E, Wodajo T, Hutchison B et al.. Feasibility and efficacy of simulation training for joint dislocation management in residency. The American journal of emergency medicine 2025. link 2 Rozzi SL, Anderson JM, Doberstein ST, Godek JJ, Hartsock LA, McFarland EG. National Athletic Trainers' Association Position Statement: Immediate Management of Appendicular Joint Dislocations. Journal of athletic training 2018. link 3 Schupp CM, Rand SE, Hanson TW, Lee BM, Jafarnia K, Jia Y et al.. Sideline Management of Joint Dislocations. Current sports medicine reports 2016. link 4 Lee YK, Chen CC, Lin HY, Hsu CY, Su YC. Propofol for sedation can shorten the duration of ED stay in joint reductions. The American journal of emergency medicine 2012. link 5 Verhelle N, Van Ransbeeck H, De Smet L. Irreducible dislocation of the interphalangeal joint of the thumb: a case report. European journal of emergency medicine : official journal of the European Society for Emergency Medicine 2003. link 6 Hutchison JD, Hooper G, Robb JE. Double dislocations of digits. Journal of hand surgery (Edinburgh, Scotland) 1991. link90146-f) 7 Stienstra JJ, Derner R. Closed reduction of a proximal interphalangeal joint dislocation. The Journal of foot surgery 1990. link 8 Rajoo RD, Govender S, Goga IE. Simultaneous dislocation of the interphalangeal joints. A report of 2 cases. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1990. link 9 Onuba O, Essiet A. Irreducible dislocation of the metacarpophalangeal joint of the thumb due to tendon interposition. Journal of hand surgery (Edinburgh, Scotland) 1987. link 10 Andersen K. Dislocation of the superior tibiofibular joint. Injury 1985. link90180-9) 11 Brewood AF. Complete dislocation of the trapezium: a case report. Injury 1985. link90129-9) 12 De Smet L, Vercauteren M. Palmar dislocation of the proximal interphalangeal joint requiring open reduction: a case report. The Journal of hand surgery 1984. link80021-0) 13 Ikpeme JO. Dislocation of both interphalangeal joints of one finger. Injury 1977. link90057-2)

Fracture dislocation of joint