Frequency of Fractures Identified on Post-Reduction Radiographs After Shoulder Dislocation.

Michael Gottlieb,John Bailitz,Anupam Basu,Laurie Krass,Errick Christian,Damali Nakitende

doi:10.5811/westjem.2015.11.28855

Michael Gottlieb, John Bailitz + Show 4 more

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https://doi.org/10.5811/westjem.2015.11.28855

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Abstract

IntroductionMost emergency physicians routinely obtain shoulder radiographs before and after shoulder dislocations. However, currently there is limited literature demonstrating how frequently new fractures are identified on post-reduction radiographs. The primary objective of this study was to determine the frequency of new, clinically significant fractures identified on post-reduction radiographs with a secondary outcome assessing total new fractures identified.MethodsWe conducted a retrospective chart review using appropriate International Classification of Diseases, 9th Revision (ICD-9) codes to identify all potential shoulder dislocations that were reduced in a single, urban, academic emergency department (ED) over a five-year period. We excluded cases that required operative reduction, had associated proximal humeral head or shaft fractures, or were missing one or more shoulder radiograph reports. All charts were abstracted separately by two study investigators with disagreements settled by consensus among three investigators. Images from indeterminate cases were reviewed by a radiology attending physician with musculoskeletal expertise. The primary outcome was the percentage of new, clinically significant fractures defined as those altering acute ED management. Secondary outcomes included percentage of new fractures of any type.ResultsWe identified 185 total patients meeting our study criteria. There were no new, clinically significant fractures on post-reduction radiographs. There were 13 (7.0%; 95% CI [3.3%–10.7%]) total new fractures identified, all of which were without clinical significance for acute ED management.ConclusionPost-reduction radiographs do not appear to identify any new, clinically significant fractures. Practitioners should re-consider the use of routine post-reduction radiographs in the ED setting for shoulder dislocations.

Highlights

Most emergency physicians routinely obtain shoulder radiographs before and after shoulder dislocations
There were 13 (7.0%; 95% CI [3.3%-10.7%]) total new fractures identified, all of which were without clinical significance for acute emergency department (ED) management
Practitioners should re-consider the use of routine post-reduction radiographs in the ED setting for shoulder dislocations. [West J Emerg Med. 2016;17(1):35–38.]

Summary

Introduction

Most emergency physicians routinely obtain shoulder radiographs before and after shoulder dislocations. Currently there is limited literature demonstrating how frequently new fractures are identified on post-reduction radiographs. Most emergency physicians (EP) routinely obtain shoulder radiographs before and after shoulder dislocations to assess for persistent dislocations and fractures. Fractures on Post-Reduction Shoulder Radiographs have demonstrated that EPs are able to detect reductions clinically with excellent accuracy.[3,4,5] the identification of new fractures on post-reduction imaging has been suggested to be low in prior studies, though most are limited by small sample sizes.[4,5,6,7,8] As a result, it has been suggested that the post-reduction radiograph may not be necessary in the ED environment.[8]

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