Postreduction radiographs for anterior shoulder dislocation: A reappraisal

Tannebaum, Ross D.; Kondabala, Rajani K.; Stockmal, Peter J.

doi:10.1067/mem.2001.113955

Cited by 2 publications

(4 citation statements)

References 4 publications

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“… 2 , 3 , 4 Earlier studies that challenged this notion suggested that in the majority of cases, physicians are able to accurately determine the joint position according to clinical clues. 2 , 3 , 4 , 11 Hendey 4 proposed a clinical decision rule for selective radiography based on the mechanism of injury, history of previous dislocations, and the physician's clinical confidence of the dislocation or relocation. The proposed algorithm showed the potential of considerably reducing the utilization of radiography without missing any persistent dislocation.…”

Section: Discussionmentioning

confidence: 99%

“…The first is iatrogenic fracture caused by the reduction maneuvers, which is hardly a concern since it very rarely occurs especially with modern less traumatic reduction techniques. 4 , 11 The second concern is persistence of the dislocation despite the reduction attempt. Rate of persistent dislocation after the first reduction attempt varies among different studies, and ranges from 0.6% 3 –3.1%.…”

Section: Discussionmentioning

confidence: 99%

“…Rate of persistent dislocation after the first reduction attempt varies among different studies, and ranges from 0.6% 3 –3.1%. 11 In cases of an unsuccessful reduction, because the medications used for procedural sedation are short-acting agents and their effects wane before the results of radiography are obtained, re-administration of the sedative medication is commonly required to perform a second attempt at reduction.…”

Section: Discussionmentioning

confidence: 99%

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Bedside ultrasonography for verification of shoulder reduction: A long way to go

Ahmadi

Hashemian

Sineh-Sepehr

et al. 2016

Chinese Journal of Traumatology

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PurposeShoulder dislocation is a common joint dislocation managed by the emergency physicians in the emergency departments. Pre- and post-reduction radiographic examinations have long been the standard practice to confirm the presence of dislocation and the successful reduction. However, shoulder ultrasonography has recently been proposed as an alternative to the radiographic examination. This study aimed to assess the accuracy of ultrasonography in evaluating proper reduction of the dislocated joint.MethodsThis was a prospective observational study. All patients with confirmed anterior shoulder dislocation were examined by both ultrasonography and radiography after the attempt for reduction of the dislocated joint. The examiners were blinded to the result of the other imaging modality. Results of the two methods were then compared.ResultsOverall, 108 patients with confirmed anterior shoulder dislocation were enrolled in the study. Ninety-one (84.3%) of the patients were males. Mean age of the participants was (30.11 ± 11.41) years. The majority of the patients had a recurrent dislocation. Bedside ultrasonography showed a sensitivity of 53.8% (95% CI: 29.1%–76.8%) and a specificity of 100% (95% CI: 96.1%–100%) in detecting inadequate reductions. The results of ultrasonography had a statistically significant agreement with the results of radiography (Kappa = 0.672, p < 0.001).ConclusionThe results suggest that the sensitivity of post-reduction ultrasound is not sufficient for it to serve as a substitute for radiography.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Bedside ultrasonography for verification of shoulder reduction: A long way to go

Ahmadi

Hashemian

Sineh-Sepehr

et al. 2016

Chinese Journal of Traumatology

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“…5 The need for both pre-reduction and post-reduction radiographs when treating anterior shoulder dislocation has recently been questioned. [6][7][8][9][10][11] The discrepancy between current recommendations and common practice prompted us to undertake a prospective study to see whether emergency physicians could identify a subgroup of patients with shoulder dislocation for whom pre-reduction radiographs would not alter management. 6 We found that when emergency physicians were clinically certain of the diagnosis of shoulder dislocation (68% of cases) they were 100% accurate, and that pre-reduction radiographs would not have changed patient management in these cases.…”

Section: Introductionmentioning

confidence: 99%

Prospective evaluation of a guideline for the selective elimination of pre-reduction radiographs in clinically obvious anterior shoulder dislocation

Shüster

Abu‐Laban

Boyd

et al. 2002

CJEM

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Objective: Research has demonstrated that experienced emergency physicians can identify a subgroup of patients with shoulder dislocation for whom pre-reduction radiographs do not alter patient management. Based on that research, a treatment guideline for the selective elimination of pre-reduction radiographs in clinically evident cases of anterior shoulder dislocation was developed and implemented. The primary objective of this study was to prospectively determine whether the treatment guideline safely eliminates unnecessary radiographs. Methods:We enrolled a convenience sample of patients who presented to our rural emergency department with possible shoulder dislocation between November 2000 and April 2001. Physicians scored their level of clinical diagnostic certainty on a 10-cm visual analogue scale prior to viewing pre-reduction radiographs (if obtained). Data were collected on clinical scoring and evaluation, compliance with the guideline, and outcomes. Results: A total of 63 patients were enrolled, ranging in age from 17 to 79 years (mean = 33); 87.3% were male. Emergency physicians were certain of shoulder dislocation in 59 (93.7%) patients (95% CI, 84.5%-98.2%) and complied with the treatment guideline in 52 patients (82.5%). Most deviations from the treatment guideline involved the elimination of post-reduction radiographs (which the guideline recommends for all patients). The treatment guideline eliminated 56 (88.9%, 95% CI, 78.4%-95.4%) pre-reduction radiographs, as compared to the standard practice of obtaining pre-reduction films for all cases of suspected shoulder dislocation (p < 0.0001) Conclusions: Experienced emergency physicians are frequently certain of the diagnosis of anterior shoulder dislocation on clinical grounds alone and can comfortably and safely use this guideline for the selective elimination of pre-reduction radiographs. Compliance with the guideline substantially decreases pre-reduction radiographs. Validation of the guideline in other settings is warranted. RÉSUMÉObjectif : Des recherches ont démontré que des médecins d'urgence expérimentés peuvent identifier un sous-groupe de patients souffrant d'une dislocation de l'épaule chez qui les radiographies pré-réduction ne modifient pas la prise en charge. À partir de ces recherches, une ligne de conduite thérapeutique pour l'élimination sélective des radiographies pré-réduction dans les cas cliniquement évidents de dislocation antérieure de l'épaule fut élaborée et mise en place. L'objectif principal de la présente étude était de déterminer de manière prospective si la ligne de conduite thérapeutique permettait d'écarter sans danger les radiographies inutiles.

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Postreduction radiographs for anterior shoulder dislocation: A reappraisal

Cited by 2 publications

References 4 publications

Bedside ultrasonography for verification of shoulder reduction: A long way to go

Bedside ultrasonography for verification of shoulder reduction: A long way to go

Prospective evaluation of a guideline for the selective elimination of pre-reduction radiographs in clinically obvious anterior shoulder dislocation

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