Abstract
OBJECTIVE: To evaluate and to compare the Spaso and Kocher reduction maneuvers in terms of efficiency, time of reduction, facileness, pain, discomfort to the patient, complications and risks, besides promoting the comparison between the two maneuvers, aiming to ground the emergency conduct. METHODS: A prospective study with 105 patients with acute shoulder dislocations were enrolled in the study between February 2011 and September 2012. The patients were randomized into two groups and they were submitted to the reduction of dislocation using the Spaso maneuver (group A) or the Kocher technique (group B) by first, second or third-year orthopedic surgery residents from our service. The results were evaluated and compared. RESULTS: There was no statistically significant difference between the two groups in terms of age, gender, timing of reduction, number of precedent episodes and complications after reduction. However, reduction was achieved in more cases using the Spaso method than it was among the Kocher group, as well as the mean duration of the reduction maneuver and discomfort were shorter in the group A patients. CONCLUSIONS: Both methods presented good results in terms of dislocation reduction and low complications rates. Nevertheless, the Spaso maneuver was more efficient, fast and easily applicable in comparison with Kocher's method. Level of Evidence I, Therapeutic.
Highlights
This study was a prospective, randomized clinical trial, approved by our institutional Ethics Research Committee (ERC), and it meets the standards of the National Research Ethics Com-All the authors declare that there is no potential conflict of interest referring to this article
An evaluation form was filled, which contained the name, registration, age, gender, affected side, dislocation time, number of previous events, fracture or any neurovascular alteration detected before the procedure, no reduction of the dislocation, and the time of reduction, resident year, comments, complications, and subjective evaluation of pain reported by the patients using a visual analogue pain scale (VAS)
Confirmation should be obtained by radiographic evaluation with the trauma series - true AP, scapular and axillary profile, as well as the neurovascular status and the presence of previously evaluated concomitant fracture.[9]
Summary
This study was a prospective, randomized clinical trial, approved by our institutional Ethics Research Committee (ERC), and it meets the standards of the National Research Ethics Com-. Reductions were performed by a single Orthopedics and Traumatology resident physician, (1st, 2nd or 3rd year), and the time required for reduction was timed with a standard clock by an assistant who did not participate in the maneuver. An evaluation form was filled, which contained the name, registration, age, gender, affected side, dislocation time, number of previous events, fracture or any neurovascular alteration detected before the procedure, no reduction of the dislocation, and the time of reduction, resident year, comments, complications, and subjective evaluation of pain reported by the patients using a visual analogue pain scale (VAS). (Figure 2) the internal rotation and extension of the already reduced limb is performed. (Figure 3) The Kocher maneuver 1,8 is described with the patient in the supine position, the affected limb adducted along the body and the elbow flexed at 90°. We proceed to internal rotation and extension, with the reduction of the shoulder. (Figure 7)
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