Anzeige
Erschienen in:
01.11.2007 | Original Article
Reduction of anterior shoulder dislocations: a basic treatment guideline based on clinical practice
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 6/2007
Einloggen, um Zugang zu erhaltenAbstract
Introduction
The shoulder is the most commonly dislocated major joint. The rate of dislocation is 17 per population per year, of which the vast majority (97%) are anterior dislocations. There exists in the literature a wide range of management options, with no clear consensus on the most effective one. This study was undertaken in an attempt to suggest basic treatment guidelines based on the clinical experience of both orthopaedic and emergency medical trainees’.
Methods
At a recent international trauma meeting 200 specialist orthopaedic and emergency medicine trainees were asked to confidentially complete a questionnaire on their management protocol for anterior shoulder dislocation. Participants were asked to describe their practice with regards to, number of reductions performed, choice of sedation/analgesia, preferred method of reduction and estimated success rate, and post-operative immobilization.
Results
Participants completed the questionnaire immediately ensuring a 100% response. The majority (92%) had performed over 20 reductions, with the remainder having performed at least 10. The most common method of sedation/analgesia was, intravenous (IV) benzodiazepine (79%), followed by IV opiate + benzodiazepine (11.5%), IV opiate alone (5%), intra-articular local anaesthetic (2.5%), nothing (2%). Kocher’s method of reduction was preferred by the majority of participants (71%) with a mean estimated success rate (MESR) of 92%, followed by the Hippocratic method (17.5%) MESR of 88%, gravitational reduction (8.5%) MESR 85%, and scapular manipulation (3%) MESR 91%. Post-reduction immobilization in internal rotation was chosen by 86%, with the remainder using a policy of immobilization in external rotation.
Conclusion
Appropriate monitoring of the patient and training of the practitioner is essential when managing an anterior shoulder dislocation. Of the 200 experienced participants in this study, the most common overall practice was the use of IV benzodiazepine, with reduction by Kocher’s method, and immobilization in internal rotation. Although this regimen may not be agreeable to all, the popularity of its use by those ‘on the ground’ implies that it is a safe and effective technique. We would suggest that this represents an effective basic management guideline for anterior dislocation of the shoulder.