Survey Of The Management Of Acute Traumatic Unilateral First-Time Anterior Shoulder Dislocation (AFSD) Among Orthopaedic Surgeons In USA

Abstract

Aim: To identify the current trend in managing acute traumatic first-time anterior shoulder dislocation (AFSD) among orthopaedic surgeons in USA and to draw comparisons with previous UK study1. Design: Postal Questionnaire among Orthopaedic Surgeons in Northern America. Method: 200 questionnaires were sent out to a random list of active members of The American Orthopaedic Society for Sports Medicine (AOSSM) throughout USA. Questions were laid out in two 'workgroups'. Basic demographic data such as type of practice and surgical specialisation were recorded. In 'Workgroup One' questions regarding method and duration of immobilisation were analysed. In 'Workgroup Two', two case scenarios stratified by age, were analysed to look into the 'postreduction' management, focusing on trend in technique of stabilisation employed. Results: The response rate was 55% (109 of 200). 26 percent of respondents derived from academic practices and the remaining 74% of respondents were from privatised institution. Majority of the respondents were regarded as 'surgeons with special interest in sports medicine' (87 of 109, 80%). This was followed by 'shoulder and elbow surgeons' and 'general orthopaedic surgeons' (12% and 8% respectively). The most popular choice of immobilisation was internal rotation (72.5%). However, 24.8% of respondents preferred the external rotation method for immobilisation as advocated by Itoi et al. The mean duration of immobilisation was 2.5 weeks (1/2 weeks to 8 weeks, Std Deviations 1.2weeks). 42.2% (46 of 109) of respondents would perform an immediate arthroscopic stabilisation in young, fit patients presenting with this type of injury. On the other hand, an overwhelming majority of the respondent opted for non-operative management in older patient presented with this problem (98%). The current trend of management in the young, active age group comprised of arthroscopic stabilisation using suture anchors, followed by immobilisation in internal rotation for average 3-4 weeks and return to sports/work at average 5 months post-surgery. Conclusion: This survey revealed variations among orthopaedic surgeons in managing AFSD on the 'front-line' within USA. There are also observational differences between the findings of this and the UK study previously published. There is a need to address the issue of immobilisation technique. Majority of surgeons used age as a criterion in determining definitive management for this injury. The current trend in managing AFSD in young and active patient who presented with AFSD is arthroscopic stabilisation using suture anchors.