130.35C , part A Then, while extending the knee joint, simultaneously apply gentle pressure on the lateral aspect of the patella to medially reposition it ( Fig 130.35C , part B) Knee mobility should be restored immediately on successful reduction If radiographs were not initially obtained, they should be obtained after reduction The use of an extended knee brace with crutches for a brief time provides appropriate restriction of activity with orthopedic follow-up within week Some patients are at risk of recurrence Elbow Joint Dislocation Indications Posterior elbow dislocation Complications Brachial artery injury Median and ulnar nerve injury as a result of stretching, entrapment, or severance Periarticular fractures of the radial head and/or coronoid process of the ulna are especially common Development of vascular compromise due to hematoma formation or soft tissue swelling Procedure Prepare the patient with intravenous narcotic pain medication and/or muscle relaxant if needed Pharmacologic sedation is strongly advised Prone approach Place the patient in the prone position on an examination table or stretcher, with the injured arm flexed about 90 degrees over the edge Then, correct any medial or lateral translation of the proximal ulna Grasp the wrist of the patient’s injured arm, and apply traction and slight supination to the forearm to distract the coronoid process from the olecranon fossa If an assistant is available, they may help by applying countertraction ( Fig 130.35D ) Using your other hand, apply pressure to the posterior aspect of the olecranon while pronating the arm When a “clunk,” along with the restoration of normal joint contour is appreciated, the reduction is complete Supine approach Place the patient in the supine position on the examination table or stretcher Have an assistant stabilize the humerus against the stretcher with both hands Grasp the wrist, and apply slow, steady, inline traction Ensure that the elbow is slightly flexed, and the wrist is supinated If not successful after approximately 10 minutes, gently flex the forearm or apply traction to the proximal volar surface of the forearm Reduction is complete after hearing or