Reduction Of Shoulder Dislocation Research Articles

Shoulder Dislocation Reduction by the Novel Prakash’s Method

1. Objectives: The aim of this study is to evaluate the effectiveness of Prakash’s Method of relocation for dislocated shoulder. 1.2. Study Design: Descriptive Study. 1.3. Setting: Sports units of Hayatabad Medical Complex, Peshawar. 1.4. Method: 30patients (30 Shoulders) were recruited for study, all patients with signs symptoms of shoulder dislocation by clinical examination were subjected to anterior/ posterior shoulder radiograph. And those diagnosed with anterior shoulder dislocations were initially enrolled in the study. Reduction was performed using Prakash's method 1.5. Results: Prakash's method had success rate of 90.0% (n=27). In 10.0% (n=3) the reductions who failed were then reduced under anesthesia using the Hippocratic method. 50.0% (n=15) patients has mild pain, 36.7% (n=11) has moderate pain, and 13.3% (n=4) has severe pain during the procedure. All patients having mild and moderate pain were reduced successfully in the first attempt. 4 patients who has severe pain out of which 1 patient was reduced successfully and 3 patients were reduced by the Hippocratic method using anesthesia. The reduction time was ranging from 180-300 seconds with a mean of 216±85 seconds. no complication occurred during the procedure. 1.6. Conclusion: Prakash Method of shoulder relocation for acutely dislocated shoulder is an effective method.

Comparing Diazepam Plus Fentanyl With Midazolam Plus Fentanyl in the Moderate Procedural Sedation of Anterior Shoulder Dislocations: A Randomized Clinical Trial.

The reduction of shoulder dislocation requires adequate procedural sedation and analgesia. The mixture of midazolam and fentanyl is reported in the literature, but long-acting benzodiazepines in conjunction with fentanyl are lacking. Our aim was to compar e IV diazepam with IV midazolam in moderate procedural sedation (based on the classification of the American Society of Anesthesiologists) for the reduction of shoulder dislocation. This was a randomized controlled clinical trial conducted from April 2019 to December 2019 in the emergency department of a university-affiliated hospital in Tehran, Iran. Participants were adult patients (aged 18-65years) with anterior shoulder dislocation. Group A (n=42) received diazepam 0.1mg/kg plus fentanyl 1μg/kg IV and group B received midazolam 0.1mg/kg plus fentanyl 1μgg/kg IV. Main outcomes measured were onset of muscle relaxation, time taken to reduction, total procedure time, number of the reduction attempts, patient recovery time, the occurrence of the adverse effects, amount of the pain reported by the patients using visual analog scale, and patients and physicians overall satisfaction with the procedure using a Likert scale question. Eighty-one patients were included. The mean±standard deviation time of the onset of the muscle relaxation and time taken to reduction was shorter in the diazepam plus fentanyl group (p=0.016 and p=0.001, respectively). Adverse effects and pain relief were not statistically different between the two groups. Patient recovery time and total procedure time was shorter in the midazolam plus fentanyl group (p=0.008 and p=0.02, respectively). The overall satisfaction of patients and physicians was higher in the diazepam plus fentanyl group. As compared with midazolam plus fentanyl, diazepam plus fentanyl was superior in terms of the onset of the muscle relaxation, patient and physician satisfaction, and time taken to reduction.

Arthroscopic reduction and subscapularis remplissage (ARR) of chronic posterior locked shoulder dislocation leads to optimized outcomes and low rate of complications.

Unrecognized posterior shoulder dislocation with a concomitant humeral head fracture affects joint function and no consensus exists regarding treatment. The present study analyses clinical and radiographic outcomes of a novel arthroscopic technique for reducing chronic locked posterior shoulder dislocation associated with subscapularis remplissage. The study comprises a retrospective analysis of consecutive chronic posterior locked shoulders (CPLS) with minimum 2-years follow-up of patients who had undergone McLaughlin technique arthroscopic modification for the treatment of CPLS with a reverse Hill-Sachs lesion. Active range of motion (ROM), Western Ontario (WOSI) and Constant Score (CS), were evaluated pre- and postoperatively. Plain radiographs and magnetic resonance imaging (MRI) scans were collected pre- and post-operatively, recording bone defect, osteoarthritis, cuff integrity/fatty infiltration, and the grade of filling of the reverse Hill-Sachs. Twelve male patients with a mean follow-up of 37.3months ± 10.5 (range, 24-58) were included. Mean WOSI and CS scores improved from 41 to 92 and 28 to 94 points, respectively. ROM measurements all had significantly increased at final follow-up, with no significant differences in arm rotation. No defects were left unfilled at final MRI examination. The results of this uncontrolled study with a limited number of patients confirm that arthroscopic reduction and subscapularis remplissage is a highly effective and satisfactory treatment method resulting in no shoulder rotation deficits. Level IV.

Self-reduction techniques taught via smartphone are effective for anterior shoulder dislocation: prospective randomized study.

To prospectively compare the effectiveness of three methods for self-assisted shoulder reduction demonstrated using a smartphone video link. Anterior shoulder dislocation is very common among young adults. Patients often seek medical assistance in the emergency department to reduce their shoulder. Many techniques for shoulder reduction had been described, some of which do not require professional assistance and can be performed by patients themselves. Patients admitted with anterior shoulder dislocation were randomized to either the Stimson, Milch or the Boss-Holtzach-Matter technique. Each patient was given a link to watch a short instructional video on his smartphone and instructed to attempt self-reduction. Success of the reduction, pain level, patient satisfaction and complications were recorded. Thestudy cohortconsisted of 58 patients (mean age was 31.6 (18-66, median = 27), 82% males, 88% right hand dominant). Success rate using Boss-Holtzach-Matter (10 of 19, 53%) and self-assisted Milch (11 of 20, 55%) were significantly higher than with the self-assisted Stimson method (3 of 19, 16%), p < 0.05. Pain levels improved from 8.4 (2-10) to 3.1 (0-10) following the reduction. Patient subjective satisfaction from the reduction attempt was 6.7 (0-10). No complications were observed. Both the Self-assisted Milch and the Boss-Holtzach-Matter techniques are ideal for reduction of anterior shoulder dislocation without medical assistance. Both methods can be successfully performed without assistance or previous education and taught using an instructional video. Level II.

77 Intra-articular Lidocaine versus Procedural Sedation for Anterior Shoulder Dislocations

Shoulder dislocations are the most common dislocations presenting to emergency departments (EDs). Due to the large groups of muscles involved, shoulder dislocation reductions are difficult to achieve for the provider if the patient's pain is not adequately controlled. There are several ways of providing anesthesia for shoulder dislocation reductions, and two of the most common are intra-articular lidocaine (IAL) injections and procedural sedation. Prior studies have found that the use of IAL is safer and results in a shorter ED length of stay (LOS) as compared to procedural sedation, but those studies used sedative medications that have fallen out of favor. The purpose of this study was to compare IAL to procedural sedation with propofol or etomidate for closed reduction of anterior shoulder dislocations. This was a single center, open label, randomized controlled trial. ED patients from 18 to 70 years old who had an anterior shoulder dislocation without an associated fracture (other than a Hill-Sachs) were eligible for enrollment. Consenting patients were randomized to either procedural sedation (with provider’s choice of propofol or etomidate) or IAL. The dose of procedural sedation medication was per provider discretion. The initial study protocol stated that patients randomized to the IAL group would receive 20mL of 1% lidocaine into the glenohumeral joint, but due to a shortage of 1% lidocaine, injections with 10mL of 2% lidocaine were also allowed. The primary outcome measure was ED LOS. Secondarily the number of attempts required for successful reduction and patient satisfaction were compared between groups. In total, 43 patients were enrolled with 23 randomized to the IAL group and 20 to the procedural sedation group. Three patients randomized to the IAL group ended up getting procedural sedation after failed attempts at reduction. In those randomized to the IAL group, the mean ED LOS was 133 minutes as compared to 124 minutes for the procedural sedation group. The difference of 9 minutes (95% CI -22 to 41) was not statistically significant (p = 0.54). Patients in the IAL group had a higher mean number of reduction attempts at 1.9 as compared to 1.2 in the procedural sedation group (difference 0.7 [95% CI 0.2 to 1.2]). The mean patient satisfaction scores were similar at 9.7 and 9.8 for the IAL and procedural sedation groups, respectively (difference 0.1 [95% CI -0.3 to 0.4]). Although this study was underpowered to detect small differences, there was no statistically significant difference in mean ED LOS or patient satisfaction for patients who received IAL for their shoulder dislocation reduction as compared to those who received procedural sedation. Patients randomized into the procedural sedation group required less number of attempts for successful reduction compared to those randomized into the IAL group.

Outcome of Immobilization in External Rotation Position after Closed Reduction in Traumatic Anterior Shoulder Dislocation

Background: As documented in many studies, anterior shoulder dislocation can be effectively immobilized in both external and internal rotation positions, with favorable outcomes. However, controversy exists about the superiority of the technique of immobilization to achieve the reduced rate of redislocation. We conducted this study to assess the functional outcome of immobilization of shoulder in external rotation position after relocation in patients with acute anterior shoulder dislocation.&#x0D; Methods: This is hospital based cross-sectional study in total of 36 patients of primary anterior dislocation of shoulder. They were managed with closed reduction and immobilization in external rotation position and followed up for up to twelve months. Functional outcome (including re-dislocation rate) during each follow-up visit was assessed by using ROWE Score.&#x0D; Results: The mean age of the participants was 29.6±7.9 years (range: 17-44 years). Of them, 89.9% were male; and 55.6% were involved in risky jobs. Similarly, 50% of them sustained injury due to slip and fall, 72.2% presented to the hospital within 12 hours; and 69.4% had their right side involved. All the patients were compliant with treatment regime; 77.8% tolerated the brace well and the redislocation rate was 8.3%. ROWE score was found to be significantly increased between subsequent follow-up visits (p&lt;0.05), except between six months and 12 months (p&gt;0.05). Overall, ROWE score varied significantly across the total follow-up period (p&lt;0.05).&#x0D; Conclusions: Immobilization in external rotation position in traumatic anterior shoulder dislocation was a simple and easy method of conservative treatment with good patient compliance, less incidence of re-dislocation and good functional outcome.

Long term outcome of ipsilateral dislocation of open displaced elbow with close shoulder dislocation: a case report

52 years old man presented with open dislocation of elbow due to road traffic accident was not complaining of another joint injury or pain was radiographed as per protocol of including the adjacent shoulder joint and incidentally discovered with anterior dislocation of shoulder was treated with close reduction of shoulder dislocation and debridement as well as reduction and trans fixation of ulno-humeral joint with k-wires. Skin coverage later was done. Patient recovery was excellent in terms of motion at both joints. The purpose of reporting of this case is to convey a message that ipsilateral dislocation of shoulder and elbow is a very rare occurrence but do occur and a high degree of suspicion and imaging protocol can save from missing this event.

Professor Theodor Kocher (1841–1917) – one of the founders of european scientific surgery (on the 100th anniversary of death)

The main milestones in the life and work of T. Kocher are presented. Illuminated little-known interesting facts from the life of a professor. T. Kocher studied the problems of asepsis and antisepsis, abdominal surgery, thyroid surgery, traumatology. He deepened his teaching of the antisepsis and asepsis, introduced the concept of Implant Infection. It is noted that Kocher has developed sterilization methods suture material. He suggested operative access to the liver and biliary tracts, an original method of gastrectomy, methods for mobilizing the duodenum, surgical treatment of inguinal hernias, which are now described in textbooks. He also developed gentle surgical approaches for the procedure on large joints (hook-shaped incisions). The reduction of shoulder dislocations according to Kocher became a part of the daily practice of surgeons and traumatologists. T. Kocher's research on the problems of diseases of the thyroid gland is world famous. T. Kocher was awarded the 1909 Nobel Prize for his work on the physiology, pathology and surgery of the thyroid gland. He proposed some surgical instruments (hemostatic clamp, grooved probe, gastric clamp, etc.), a gastric tube was put into practice. The published manual on operative surgery has survived 5 reprints (1892–1907) and has been translated into many world's languages.

P007: Cunningham reduction of anterior shoulder dislocation facilitated by inhaled low-dose methoxyflurane – a pilot study

Introduction: The Cunningham reduction method for anterior shoulder dislocation offers an atraumatic alternative to traditional reduction techniques without the inconvenience and risk of procedural sedation and analgesia (PSA). Unfortunately, success rates as low as 27% have limited widespread use of this method. Inhaled methoxyflurane (I-MEOF) offers a rapidly administered, minimally invasive option for short-term analgesia. We conducted a pilot study to evaluate the feasibility of studying whether I-MEOF increased success rates for atraumatic reduction of anterior shoulder dislocation. Methods: A convenience sample of 20 patients with uncomplicated anterior shoulder dislocations were offered the Cunningham reduction method supported by methoxyflurane analgesia under the guidance of an advanced care paramedic. Operators were instructed to limit their attempt to the Cunningham method. Outcomes included success rate without the requirement for PSA, time to discharge, and operator and patient satisfaction with the procedure. Results: 20 patients received I-MEOF and an attempt at Cunningham reduction. 80% of patients were male, median age was 38.6 (range 18-71), and 55% were first dislocations of that joint. 35% (8/20 patients) had reduction successfully achieved by the Cunningham method under I-MEOF analgesia. The remainder proceeded to closed reduction under PSA. All patients had eventual successful reduction in the ED. 60% of operators reported good to excellent satisfaction with the process, with inadequate muscle relaxation being identified as the primary cause of failed initial attempts. 80% of patients reported good to excellent satisfaction. Conclusion: Success with the Cunningham technique was marginally increased with the use of I-MEOF, although 65% of patients still required PSA to facilitate reduction. The process was generally met with satisfaction by both providers and patients, suggesting that early administration of analgesia is appreciated. Moreover, one-third of patients had reduction achieved atraumatically without need for further intervention. A larger, randomized study may identify patient characteristics which make this reduction method more likely to be successful.

A meta-analytic comparison of 8 methods of closed anterior shoulder dislocation reduction

Background: Anterior shoulder dislocation is a common injury, accounting for 95% of all shoulder injuries. However, many doctors and hospitals do not have a fixed protocol for the treatment of dislocations. The current study have compared 8 different techniques for shoulder dislocation reduction in this study. Methods: Eight different methods namely the Scapular Manipulation, Matsen’s Traction-Countertraction, Kocher’s, Spaso, External Rotation, Cunningham, Modified Milch, and the FARES methods were compared on the basis of efficacy, pain experienced during reduction (VAS score), and time taken for reduction. Results: The Matsen’s Traction-Countertraction method had the highest efficacy, while the Scapular Manipulation method had the least VAS scoring. The FARES Method had the fastest reduction time on average. Interpretation and Conclusions: As per the data analyzed, the FARES and Scapular Manipulation method appear to be the most effective in reducing anterior dislocations, having consistently high success rates, and low VAS scores and reduction times. These 2 methods may be recommended to new practitioners to treat acute shoulder dislocations.

Interscalene brachial plexus nerve block in the emergency department: an effective and practice-changing workshop

BackgroundThe interscalene brachial plexus nerve block (ISNB) is a potentially useful method of regional analgesia for humerus fracture and shoulder dislocation reduction in the Emergency Department (ED). We examined the effectiveness of an ISNB workshop given to emergency medicine (EM) residents. We also explored complication rates and effectiveness of ISNBs performed in the ED.MethodsOne-hour evidence-based ISNB workshops were conducted with EM residents. Participants were given pre-, post-, and 3-month post-workshop knowledge and technical assessments. Results were analyzed using descriptive statistics. A pre- and post-workshop chart review examined ISNB utilization, complications, post-ISNB opiate administration, and post-ISNB procedural sedation.Results41 residents enrolled in the workshop. Pre-workshop pass rate: knowledge assessment 22%. Immediate post-workshop pass rates: knowledge assessment 100%, image acquisition 93%, needle placement 100%. Three months post-workshop pass rates: knowledge assessment 73%, image acquisition 76%, needle placement 100%. Areas of poorest knowledge retention were anatomical landmarks, block distribution, and early signs of LAST. In the chart review, 2 ISNBs were performed in the pre-workshop period, and 12 in the post-workshop period. No serious complications were recorded. 78.5% of attempted ISNBs were successful, without need for procedural sedation. Of the 11 successfully performed ISNBs, 91% received no opiates after the procedure.ConclusionsOur study suggests that EM residents can learn the ISNB, perform it safely in the emergency department, and that the ISNB may be an alternative to procedural sedation and opiate use for shoulder dislocation. Residents are adept at ISNB technical skills but demonstrate some deficits in knowledge retention.

Reducing shoulder dislocation without anaesthesia or assistant: Validation of a new reduction manoeuvre

PurposeShoulder dislocation comprises 60% of all major joint dislocations worldwide and a number of reduction techniques are described in the literature with varying degrees of success. The description of a large number of techniques speaks for itself that no method is effective all the times and one should be acquainted with more than one technique. An ideal method of reduction should be simple, easily reproducible, relatively painless that can be performed unassisted without sedation or anaesthesia with minimal or no further complications. We report our results of using a novel method of anterior shoulder reduction described recently in the literature that claims to fulfil most of the characteristics of an ideal method if not all. MethodsThis prospective study was conducted in a tertiary care centre. All the cases of primary anterior shoulder dislocation presenting within three days of injury without any associated fracture or spine trauma with or without greater tuberosity fracture were included. The reduction was done using a novel method by orthopaedic residents in all cases. The need for a second reduction attempt or anaesthesia was considered a treatment failure. Time taken for reduction, pain felt during reduction and complications if any were noted. ResultsThere were 47 (77.04%) males and 14 (22.95%) females with a mean age of (37.04 ± 12.63) years. The new technique was effective in locating a shoulder dislocation on the first attempt in 58 of the 61 dislocated shoulders (95.08%). The remaining three shoulders were reduced on second attempt by the same technique. Sedative, pre-medication or anaesthesia was not used in any case. The average time taken for the shoulder reduction was (130.5 ± 25.8) seconds and confidence interval (95%) 124–137 s. Iatrogenic complications were not seen in any of the patients. ConclusionThis relatively painless technique of shoulder reduction is easy to acquire and practice in emergency department. The advantages of this manoeuvre and its associated safety may justly lead surgeons to select it as their primary method for reduction of anterior shoulder dislocations.

Conservative management following closed reduction of traumatic anterior dislocation of the shoulder.

Conservative management following closed reduction of traumatic anterior dislocation of the shoulder.

Quebec Decision Rule in Determining the Need for Radiography in Reduction of Shoulder Dislocation; a Diagnostic Accuracy Study.

The Quebec Decision Rule (QDR) has been developed for deciding on the necessity of radiography for patients with shoulder dislocation. This study aimed to investigate the diagnostic value of QDR in this regard. This diagnostic accuracy study was conducted on patients with shoulder dislocation visiting the emergency department. After filling out the QDR-based checklist for all patients, they underwent radiography and the obtained radiography results were compared to QDR-based clinical diagnostic findings. 143 patients with the mean age of 32.1±12 years were evaluated (88.8% males). Sensitivity, specificity, and positive and negative predictive values of QDR were 50%, 58.2%, 3.3%, and 97.6%, respectively. The sensitivity and specificity were 100% and 50% in patients >40 years old, and 33.3% and 59.8% in those <40 years old. These indices were 33.3% and 60.4%, respectively, in the male sex and 100% and 40% in the female sex. ‌ Quebec decision rule holds promise to diagnose concomitant fractures in patients over the age of 40 with 100% sensitivity, thereby reducing the number of radiographies by 50% without causing diagnostic errors. In contrast, this criterion proved inefficient in patients younger than 40. ‌.

Remifentanil versus Propofol/Fentanyl Combination in Procedural Sedation for Dislocated Shoulder Reduction; a Clinical Trial.

Procedural sedation and analgesia (PSA) is a fundamental skill for every emergency physician. This study aimed to compare the PSA characteristics of remifentanil with propofol/fentanyl combination. In this double-blind randomized clinical trial, the procedural characteristics and number of failures, as well as adverse events were compared between groups treated with either remifentanil or propofol/fentanyl combination consisting of 15-60 year old patients referring to emergency department following acute anterior shoulder dislocation. 64 patients were randomly assigned to either remifentanil (32 cases) or propofol/fentanyl, (32 cases) groups. The two groups were similar regarding mean age, sex, and pain severity at the time of presentation to ED. The two regimens had the same efficiency regarding pain management (100% success rate). 22 (68.8%) cases in remifentanil group and 4 (12.5%) cases in propofol/fentanyl group had failed in muscle relaxation (p < 0.001). In the group receiving remifentanil, onset of action (p = 0.043) and recovery time (p < 0.001) were significantly shorter. 10 (31.3%) cases in remifentanil group and 11 (34.4%) cases in the other group experienced adverse events (p =0.790). There was a significant difference between groups regarding the type of adverse events (p = 0.003). Compared to propofol/fentanyl combination, remifentanil has equal efficiency in pain management, lower success rate in muscle relaxation, significantly higher frequency of apnea, and shorter onset of action and recovery times in PSA for reduction of anterior shoulder dislocation.

The Efficacy of External Rotation Method for The Reduction of Acute Anterior Shoulder Dislocation With and Without Greater Tuberosity Fracture

Introduction: Several methods of reduction technique have been described for the anterior dislocation of shoulder but none technique is said to be ideal. The aim of this study was to show the efficacy of external rotation method which could be safe and painless method for the reduction of the acute anterior shoulder dislocation with or without fracture of the greater tuberosity and to search the cause of failure of reduction.Objective: Objective of this study was to assess the efficacy of the external rotation method for reduction of acute anterior shoulder dislocation and to find the cause of failure of reduction.Methodology: All cases of anterior dislocation encountered in emergency department reduced by external rotation method by consultant orthopedic surgeon using basic emergency setting for resuscitation were included in the study. Fifty cases of shoulder dislocation was treated by this method and prospective evaluation done with regard to type of dislocation, the effectiveness of the procedure in achieving reduction, the need for pre-medication, the ease of performing reduction and complication if any.Results: Out of 50 cases, successful reduction was achieved in 42 patients. Premedication was not required in 36 successful reduction. Average time of reduction was 2 minutes in 30 patients and 5 minutes in 8 patients. Four Patients complained severe pain during reduction process. This method was not successful in 8 patients 2 of whom had displaced greater tuberosity fracture.Conclusion: The external rotation method is reliable and safe method for the reduction of acute anterior shoulder dislocation which can be performed relatively with less pain for both subcoracoid and subglenoid dislocation provided there is no displaced fracture of the greater tuberosity. BJHS 2018;3(2)6: 408-412.

The Efficacy of Matrix Model Treatment in the Reduction of Addiction Severity and Relapse Prevention among Amphetamine Abusers

Comparison of Sedatives for the Reduction of Shoulder Dislocation Based on Bispectral Index System in Emergency Department: A Randomized, Three-Group, Double-Blinded Clinical Trial

Closed Treatment of Shoulder Dislocation in Children With Birth Brachial Plexus Injuries

There is no financial information to disclose. With earlier recognition of shoulder dysplasia, is there a role for intervention with closed shoulder reduction and botulinum toxin injections to improve shoulder dysplasia or prevent future open procedures? Early ultrasound identification and closed treatment of glenohumeral dysplasia in patients with birth brachial plexus injuries (BBPI) and shoulder subluxation can prevent worsening deformity and decrease the need for open shoulder reduction. 26 consecutive patients with BBPI who underwent closed shoulder reductions with or without botulinum toxin injections at a mean age of 6.5 months (range 3–19 months) were followed to failure of treatment (n = 18) or to an average follow-up of 40 months (range 12–66 months). All children included in the study were identified clinically by loss of passive external rotation (PER) with imaging confirming shoulder dislocation (Figure 23-1). All children were treated with closed reduction of the glenohumeral joint under general anesthesia and were casted in maximum shoulder external rotation (ER) (Figure 23-2). Treatment outcomes were assessed by changes in ER and ultrasound measurements of humeral head coverage (HHC) and alpha angle. Descriptive and comparative statistics were performed for all patients with available follow-up for preoperative versus postoperative AMS shoulder ER, PER, ultrasound percent HHC, and alpha angle for initial postoperative values (average 11 weeks). For patients undergoing open reduction, subgroup analysis was performed. Final outcome measures for patients not requiring subsequent open reduction were compared with preoperative measures for AMS and shoulder position. Active Movement Scale shoulder external rotation score improved by 0.7 posttreatment. Passive external rotation increased by 42° (P < .001). Humeral head coverage improved by 39% (P < .001). Alpha angle improved by –41° (P < .001). 18 patients (69%) required an open reduction and tendon transfer of the affected shoulder at an average of 13.4 months (range 1–47 months) after the index procedure. 7 patients (27%) did not require further open shoulder reduction. Of these 7 patients, 2 needed repeated botulinum toxin injections, and 1 repeated closed reduction and nerve transfer. 1 patient was lost to follow -up. The age at the time of closed shoulder reduction was significantly lower in the 7 children who did not require subsequent open reduction. •Early closed reduction of shoulder dislocation in patients with birth brachial plexus injuries improves PER, HHC, and alpha angle.•Early detection and closed treatment can prevent subsequent open reduction in 27% of children.•The authors recommend ultrasound screening of all children with BBPI and loss of PER.Figure 23-2All patients were immobilized for 4–6 weeks with the arm in 30° abduction and maximum external rotation with intraoperative ultrasound confirmation of shoulder reduction.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

FARES method for reduction without medication of first episode of traumatic anterior shoulder dislocation.

The aim of this study is to demonstrate the efficiency of (FARES) method for reduction of first-episode anterior shoulder dislocation, as well as its safety, reliability, and quick easy reproducibility by inexperienced physicians without any use of medications. This was a prospective study of 28 patients with first episode of anterior shoulder dislocation that underwent closed reduction using FARES method by junior orthopaedic residents without use of any analgesic, muscle relaxant, or anesthesia. Only two attempts of reduction were allowed for each patient. The time needed for reduction was recorded, and the patients were asked to grade their pain according to a visual analog scale from 0 to 10. Reduction was achieved after one attempt in 21 patients (75%) and after two attempts in three additional patients (total 85.7%). The mean time needed for reduction was 62.66seconds, and the mean visual analog scale for pain evaluation was 5.29. FARES method is a fast, reliable, and safe method for reduction of a first episode of anterior shoulder dislocation and can be easily performed by inexperienced physicians and junior residents.

Our experience with the external rotation method in the reduction of anterior dislocation of the shoulder

Background: Dislocations of the shoulder are injuries frequently seen in the emergency department with the anterior type being the most common. Various methods are available in the reduction of these dislocations. The aim of this study was to evaluate the role of the External rotation method (ERM) in the reduction of these dislocations and to compare the results with that of other authors as available in literature. Methods: 45 patients with anterior dislocation of the shoulder who presented between January 2013 to January 2015 reduced by the external rotation method were included in our study. Results: There was a male preponderance seen in our study with the right side being most commonly affected. The most common mode of injury was slip and fall followed by sports injuries. There were 41 primary and 4 cases of recurrent shoulder dislocations. Sub coracoid type was the most common type seen. 3 patients had associated greater tuberosity fractures out of which one patient required fixation with cannulated cancellous screws. The time taken for reduction ranged from 1.5 to 5 mins with most of the cases reduced within 2 minutes. We had a success rate of 93.3% with no complications encountered in our study. Conclusion: We conclude that the ERM is a simple, safe and easily reproducible procedure for the reduction of shoulder dislocations. It does not cause much discomfort to the patient and gives consistent reductions without the risk of iatrogenic complications associated with other methods of reduction.