Reduction Of Acute Anterior Dislocation Research Articles

COMPARISON OF SUCCESS RATE BETWEEN EXTERNAL ROTATION METHOD AND MILCH METHOD FOR REDUCTION OF ACUTE ANTERIOR DISLOCATION OF SHOULDER JOINT

Objective: To compare External Rotation Method with Milch method for reduction of acute anterior dislocation of shoulder joint.
 Study Design: Randomized controlled trial.
 Place and Duration: The Department of Orthopedic Surgery, Services Hospital Lahore, from May 2016 to December 2016.
 Materials and Methods: 110 patients of acute anterior dislocation of shoulder joint were randomly distributed into two groups. Reduction of shoulder joint was achieved with External Rotation Method in Group A while Milch method was employed in Group B and there outcomes were compared. Data was entered and analyzed using SPSS for windows (version 21). P-value < 0.05 was considered significant.
 Result: Statistical difference between success rate of External Rotation (72.7%) and Milch Method (74.5%), was insignificant (p=0.828)
 Conclusion: Though external rotation method is easy to perform, both methods can be used in reduction of acute anterior dislocation of shoulder joint.

Comparison between external rotation method and milch method for reduction of acute anterior dislocation of shoulder.

Anterior dislocation of shoulder account for more than 50% of dislocation that occur in our body. Several methods of reduction are described in literature which are painful or require anaesthesia. This study was undertaken to compare the External Rotation Method and Milch method for reduction of anterior dislocation of shoulder. There were total 52 patients with anterior dislocation of shoulder, distributed randomly into 2 groups. Reduction was done by External Rotation Method and Milch Method for each group and their outcome were compared. The data was analysed by using SPSS for Windows (version 16.0) by applying the Chi-Square test. p-values of <0.05 was considered as significant. Among each group of 26 patients, three patients required anaesthesia in External Rotation Method and eight patients required anaesthesia in Milch Method. There was no statistically significant difference in success rate between external rotation (88.46%) and Milch (69.23%) methods of reduction (p=0.09). Both methods of reduction can be used for reduction of anterior dislocation of shoulder without anaesthesia but external rotation method was found to be easier and less painful.

Reduction of Acute Anterior Dislocation with the FARES Method.

The FARES (Fast, Reliable, and Safe) method is a new way to reduce acute anterior glenohumeral dislocations that combines the application of gentle longitudinal traction, vertical oscillation movements, and abduction and external rotation of the arm. Place the patient supine on a stretcher, with his/her elbow extended, and advise him/her to hold the stretcher with the opposite hand. Convince the patient that his/her cooperation is necessary for a better outcome. Holding the patient's hand with both of your hands, with his/her elbow extended and forearm in neutral rotation, start the procedure at 30° of shoulder abduction. Applying gentle longitudinal traction to keep the arm extended, add gentle vertical oscillating movements. Gradually abduct the arm to 90° and then gradually externally rotate the arm to achieve full external rotation. The dislocation is usually reduced once 120° to 150° of shoulder abduction has been achieved. In our previously published prospective randomized study, the FARES method was compared with the Hippocratic and the Kocher methods12. IndicationsContraindicationsPitfalls & Challenges.

A prospective randomised clinical trial comparing FARES method with the Eachempati external rotation method for reduction of acute anterior dislocation of shoulder

ObjectiveTo compare the safety, efficacy and reliability of FARES (fast, reliable and safe) method with the Eachempati external rotation method for reduction of anterior dislocation of shoulder. MethodsIn a single centre, prospective, randomised clinical trial, conducted in our institution from January 2010 to October 2011, 160 patients with acute anterior dislocation of shoulder (with or without an associated fracture of the greater tuberosity of the humerus) who satisfy the inclusion and exclusion criteria were enrolled in the study. Patients were randomised to receive reduction of dislocation with one of the two methods (FARES and Eachempati method) with 80 patients in each group, according to a table of random numbers. Following successful reduction, the following information was recorded: (i) intensity of pain perceived during reduction by using a visual analogue scale (VAS) ranging from 0 (no pain) to 100 (worst pain possible), (ii) time interval between the dislocation and the first attempt of reduction, (iii) time interval between the start of the reduction manoeuvre and completion of the reduction, (iv) number of attempts taken to complete the reduction and (iv) any post-reduction complications. ResultsThere were no significant differences between the two groups with regard to baseline characteristics. No post-reduction complications were noted in any of the patients in this study. Successful reduction of shoulder dislocation was achieved with the FARES method in 76 (95%) of 80 patients and with the Eachempati external rotation method in 73 (91.25%) of 80 patients. This difference was not statistically significant (p=0.53, Fisher's exact test). Post-reduction result analysis shows that there was a statistically significant difference between the two methods in favour of the FARES method in terms of speed of reduction, pain felt during reduction and number of attempts taken during reduction. ConclusionsFARES method, as compared with the Eachempati method, is significantly faster, less painful and less number of attempts required for reduction. As both the methods appeared to be safe and effective compared to the previous traditional techniques, we strongly recommend FARES method as the first-choice method compared to Eachempati method for reduction of acute anterior dislocation of shoulder. Level of evidenceTherapeutic Level I.

Reduction of Acute Anterior Dislocations: A Prospective Randomized Study Comparing a New Technique with the Hippocratic and Kocher Methods

Reduction of Acute Anterior Dislocations: A Prospective Randomized Study Comparing a New Technique with the Hippocratic and Kocher Methods

Reduction of Acute Anterior Dislocations: A Prospective Randomized Study Comparing a New Technique with the Hippocratic and Kocher Methods

There are several methods to reduce anterior shoulder dislocations, but few studies have compared the efficacy, safety, and reliability of the different techniques. As a result, deciding which technique to use is seldom based on objective criteria. The aim of the present study was to introduce a new method to reduce an anterior shoulder dislocation, which we have termed "FARES" (Fast, Reliable, and Safe), and to compare it with the Hippocratic and Kocher methods in terms of efficacy, safety, and the intensity of pain felt by the patient during reduction. Between September 2006 and June 2008, a total of 173 patients with an acute anterior shoulder dislocation (with or without a fracture of the greater tuberosity) were enrolled in the study. One hundred and fifty-four patients, who met all inclusion criteria, were randomly assigned to one of the three study groups (FARES, Hippocratic, and Kocher) and underwent reduction of the dislocation by first or second-year orthopaedic surgery residents. A visual analog scale was used to determine the intensity of the pain felt by the patient during reduction. Demographically, the groups were comparable in terms of age, male:female ratio, the mechanism of dislocation, and the mean time between the injury and the first attempt at reduction. Reduction was achieved with the FARES method in 88.7% of the patients, with the Hippocratic method in 72.5%, and with the Kocher method in 68%. This difference was significant, in favor of the FARES method (p = 0.033). The mean duration of the reduction maneuver was significantly shorter for the FARES method (2.36 +/- 1.24 minutes for the FARES method, 5.55 +/- 1.58 minutes for the Hippocratic method, and 4.32 +/- 2.12 minutes for the Kocher method; p < 0.001), and the mean visual analog pain score was significantly lower for the FARES method (1.57 +/- 1.43 for the FARES method, 4.88 +/- 2.17 for the Hippocratic method, and 5.44 +/- 1.92 for the Kocher method; p < 0.001). No complications were noted in any group. The FARES method is a significantly more effective, faster, and less painful method of reduction of an anterior shoulder dislocation in comparison with the Hippocratic and Kocher methods. It is easily performed by only one physician, it is applicable to anterior shoulder dislocations as well as simple fracture-dislocations, and its use is associated with no more morbidity than that associated with the other two methods.

The external rotation method for reduction of acute anterior shoulder dislocations

BackgroundShoulder dislocations account for almost 50% of all joint dislocations, and are most commonly anterior (90–98%) and occur due to trauma. This prospective study was conducted to report our experiences of using the external rotation method (ERM) in the reduction of acute anterior shoulder dislocation.Materials and methodsBetween August 2006 and April 2007, ERM was applied to 31 patients who presented with traumatic anterior shoulder dislocation to the Emergency Department of our Hospital which is a level 2 trauma centre. We evaluated the type of dislocation, the effectiveness of the procedure in achieving reduction, the need for premedication, the ease of performing the reduction, and complications, if any.ResultsOf the 31 patients, 29 had a successful reduction. No premedication was required in 25 patients who had a successful reduction, and the average time required for reduction in 25 was less than 2 min. Only five patients reported severe pain during the process of reduction. The method was not successful in two patients in whom the reduction was achieved under narcosis. We experienced a success rate of 89% at the first attempt. None of the patients encountered any complication.ConclusionsERM for the reduction of acute anterior dislocation of the shoulder is a safe and reliable method, mainly without requirement for any sedatives or opiate analgesics, that can be performed relatively painlessly for anterior shoulder dislocations. As no single method has a 100% success rate, ERM is a useful one to know.

The External Rotation Method for Reduction of Acute Anterior Dislocations and Fracture-Dislocations of the Shoulder

Several methods of reducing an acute anterior dislocation of the shoulder have been described. The aim of this study was to assess the effectiveness of the external rotation method in the reduction of acute anterior shoulder dislocations with and without fractures of the greater tuberosity and to evaluate the causes of failure. Senior and junior orthopaedic residents attending in the Emergency Department were instructed in the external rotation method for the reduction of a shoulder dislocation in a classroom setting. Forty patients with an acute anterior dislocation of the shoulder, with or without an associated fracture of the greater tuberosity, who were treated with this method were evaluated prospectively. Data sheets completed by the orthopaedic residents when this method was used were evaluated with regard to the type of dislocation, the effectiveness of the procedure in achieving reduction, the need for premedication, the ease of performing the reduction, and complications, if any. Of the forty patients, thirty-six had a successful reduction. No premedication was required in twenty-nine patients who had a successful reduction, and the average time required for reduction in twenty patients was less than two minutes. Only four patients reported severe pain during the process of reduction. The method was not successful in four patients, two of whom had a displaced fracture of the greater tuberosity. The external rotation method for the reduction of an acute anterior dislocation of the shoulder is a safe and reliable method that can be performed relatively painlessly for both subcoracoid and subglenoid dislocations provided that a displaced fracture of the greater tuberosity is not present.

Reduction of acute anterior dislocations of the shoulder without anaesthesia in the position of maximum muscular relaxation.

This paper describes the results obtained in treating 128 acute anterior dislocations of the shoulder by a method of reduction which obtains the maximum degree of muscular relaxation without general anaesthesia. Excellent results were obtained. Subcoracoid dislocations were more difficult to reduce than subglenoid.

New method for reduction of acute anterior dislocation of the mandible

New method for reduction of acute anterior dislocation of the mandible

Irreducible acute anterior dislocation of the shoulder due to a loose fragment from an associated fracture of the greater tuberosity

Failure of manipulative reduction of acute anterior dislocation of the shoulder can occur from the interposition of an avulsed greater tuberosity. The treatment is surgical and good functional results can be achieved even in late cases.

ACUTE ANTERIOR DISLOCATION OF THE SHOULDER

Perhaps no far-reaching conclusions should be drawn from this small series of twentyseven cases of acute anterior dislocation of the shoulder. However, it seems fair to say that: 1. The pathological findings in acute anterior dislocation of the shoulder are not the same in every case. 2. The injury depends upon the causative force. Hyperabduction will tear the capsule from the neck of the humerus and, if severe enough, will tear part or all of the attachment of the subscapularis tendon away from the humerus. If a force of impaction is added as the arm goes into abduction, the labrum glenoidale and the capsule will tear from the neck of the scapula, also in a longitudinal direction. 3. Reduction of acute anterior dislocations is accomplished with the least amount of trauma by traction and adduction, with the fist high in the axilla. 4. Most recurrent dislocations of the shoulder are the result of too early and too vigorous use of the shoulder, before the capsule has had time to heal and to reattach itself to the neck of the humerus or the neck of the scapula. An eight-week period of immobility in an apparatus which will prevent abduction and external rotation gives the best results.