Are postreduction anteroposterior and scapular Y views useful in anterior shoulder dislocations?

Abstract

Anterior shoulder dislocations account for greater than 50% of all joint dislocations. There are few published reports on the actual incidence of this injury; however, estimates for lifetime incidence for a first episode of anterior shoulder dislocation range from 0.82% and 1.7% of the population. ‘.* Almost all anterior shoulder dislocations can be reduced in the emergency department (ED) using a variety of techniques as well as intramuscular or intravenous analgesics. Most humeral head fractures are of the Hill-Sachs or avulsion type and do not preclude reduction. Fractures of the humeral neck, however, should be referred to an orthopedic surgeon without attempting reduction. It is the present standard of care in the United States for physicians to obtain both prereduction and postreduction x-ray films of the shoulder. Reasons cited for obtaining postreduction x-ray films include documenting reduction and ruling out any fractures not visualized on prereduction x-ray films. The risk of causing fracture during the reduction process is extremely low, but is given as a medicolegal reason for postreduction x-ray films. Prior to beginning this study, we observed that most postreduction x-ray films were read as normal and that most reductions were clinically obvious to both physician and patient, making us question the reasons for requesting postreduction x-ray films. This study looks at the need for postreduction radiographs in uncomplicated anterior shoulder dislocations.