- Parvin's Method of Closed Reduction:
- pt lies prone on stretcher, & physician applies gentle downward traction on the wrist for a few minutes;
- as olecranon begins to slip distally, MD lifts up gently on arm;
- alternatively MD may guide reduction of olecranon w/ opposite hand;
- longitudinal traction followed by flexion of the elbow usually succeeds in obtaining a congruent reduction.
- Assessment of Stability:
- passive ROM to w/in 20 deg of full extension w/o subluxation implies a stable reduction;
- in 58 traumatic dislocations, closed reduction failed in 10% of cases.
- Post Op Vascular Check:
- during reduction, the brachial artery, median and ulnar nerves are most vulnerable, and can be entrapped with manipulation;
- loss of pulse does not preclude attempted closed reduction, however, if arterial flow is not reestablished after reduction, and the hand is
poorly perfused, the patient should be prepared for immediate arterial reconstruction with saphenous vein grafting;
- if perfusion of the forearm and hand has been poor because of delayed treatment, volar fasciotomy should be performed to reduce the
chance of Volkmann's contracture;
- Failed Closed Reduction:
- failure to achieve closed reduction should suggest an entrapped medial epicondyle, inverted cartilaginous flap, or osteochondral fragment.