The Management of Acute Traumatic Primary Anterior Shoulder Dislocation in Young Adults

Abstract

The risk of recurrent instability, subsequent to primary traumatic anterior shoulder dislocation that has been managed conservatively, is highest in young patients. The overall risk is 58%, with up to 87% of problems being noted within 2 years. The majority of young patients sustain an anterior glenoid labral detachment (Bankart lesion) leading to instability problems. This comprehensive literature review explores the evidence for both conservative and surgical management in young patients sustaining a primary traumatic anterior shoulder dislocation. There is no consensus on length or type of shoulder immobilization for conservative management. The initial evidence suggesting that immobilization in external rotation is beneficial has subsequently been contradicted. A prolonged period of immobilization has also failed to show any benefit. The randomized control trial evidence shows a consistent and significant reduction in recurrent instability risk with acute stabilization surgery. The gold standard surgical approach of open stabilization (Bankart repair) is now closely matched in outcome by contemporary arthroscopic stabilization. Significant bone defects must be excluded as these lead to failure of soft tissue stabilization surgery (Bankart repair) and require a tailored management strategy. Young males, including those involved in contact sports and overhead activities, have the highest instability risk and would gain the greatest benefit from acute stabilization surgery.