Hippocratic method for reduction of chronic locked anterior shoulder dislocations.

Abstract

Old shoulder dislocations are usually treated by a variety of surgical approaches. Closed reduction of chronic unreduced dislocation is less widely reported. This study was to evaluate the outcome of reduction of old anterior shoulder dislocations using the Hippocratic method. Between January 2008 and July 2016, patients with unilateral old shoulder dislocations included 10women and three men with an average age of 60.00± 2.83years. Eight dislocations involved the right shoulder and five the left shoulder. The average delay between dislocation and treatment was 4.46± 0.97weeks (ranging from 3weeks to 6weeks). One case also had a greater tuberosity fracture. No patients had distal nerve or artery dysfunction. The patients were all healthy prior to dislocation, i.e., no diabetes, hypertension, or heart disease, etc. Dislocations were diagnosed according to anteroposterior shoulder X‑rays. Shoulder function was assessed using the Constant-Murley score. All manual reductions were conducted under general anesthesia using the Hippocratic method. All shoulder dislocations were successfully reduced with the Hippocratic method. The mean time of closed reduction was 31.46± 7.60 min and the mean hospitalization time was 2.77± 1.09days. No neurovascular injury or humerus fractures were noted during hospitalization. The Constant-Murley scores before reduction and after reduction were 34.31± 7.25 and 60.92± 8.95, respectively. These scores were significantly higher after reduction compared with before reduction (P< 0.01). No recurrent dislocation was observed in any patients during the follow-up period. The closed reduction of old anterior shoulder dislocations using the Hippocratic method is not unfeasible and should be attempted in selected patients.