Survey of the Management of Acute Traumatic First-Time Anterior Shoulder Dislocation Among Trauma Clinicians in the UK

Abstract

INTRODUCTION The aim of this work was to survey how acute traumatic first-time anterior shoulder dislocation (AFSD) is managed among trauma clinicians in UK using a postal questionnaire.PATIENTS AND METHODS A total of 150 questionnaires were sent out to active consultant members of the British Trauma Society in the UK. Questions were laid out in two 'workgroups'. In Workgroup One, an assortment of questions was included regarding choices and methods of analgesia, methods of monitoring used, methods of reduction, and position of immobilisation. In Workgroup Two, three different case scenarios were analysed to look into the 'post-reduction' management. RESULTS The response rate was 60%. Of respondents, 22% have a local protocol for managing AFSD. Almost all respondents recommended pre-and post-reduction X-rays as standard practice. Most respondents favoured systemic analgesia and sedation with airways' monitoring, as opposed to intra-articular anaesthesia (68 versus 9). Eighty-four respondents advocated immobilisation in internal rotation compared to six in external rotation. Only 19% (16 of 84) of respondents would perform an immediate arthroscopic stabilisation in young, fit patients presenting with this type of injury.CONCLUSIONS This survey revealed variations among trauma clinicians in managing AFSD on the 'front-line'. There is a need to address the issue of intra-articular analgesia, immobilisation technique and management of AFSD in the young patient with regards to immediate surgical intervention. We suggest that these issues be revised and clarified, ideally in a randomised, controlled, clinical trial prior to the introduction of a protocol for managing this problem.

Acute first-time shoulder dislocation

“…30 They reported that a standard management protocol is still not present and there are no standard guidelines for the management of anterior shoulder dislocation. Of the 90 clinicians involved in the study (orthopaedic surgeons, accident and emergency consultants and consultant anaesthetists) only 22 said they used a local protocol.…”

Stand der zementierten Hüftendoprothetik in Deutschland 2010

“…Die Rückläuferquote von 51,8 % aus deutschen Krankenhaus-bzw. Belegabteilungen entspricht den Ergebnissen anderer vergleichbarer Umfragen[13,14] und der von uns im Jahr 2005 durchgeführten Erhebung, auch wenn eine stärkere Beteiligung wünschenswert gewesen wäre. Die Zusammensetzung der ausgewählten Abteilungen nach Fachrichtung als auch deren Verteilung über das Bundesgebiet entspricht der befragten Gesamtheit.…”

Dislocations of the shoulder joint

“…Non-operative post-reduction management has been the main stay of UK orthopaedic surgeons over the years (Freudmann and Hay, 2004;Chong et al, 2006). However, the literature shows a mixed picture of results with no cohesive protocol seeming to make any difference in terms of reducing recurrence rates of dislocation (Paterson et al, 2010).…”

“…There is a wide-ranging opinion in the literature about what constitutes ideal post-reduction management, but as usual, the options of non-operative versus operative management have sparked an ongoing debate. In a recent survey, most UK orthopaedic surgeons prefer to treat acute shoulder dislocations non-operatively in a sling in internal rotation (Chong et al, 2006). However, the risk of recurrent shoulder dislocation and ongoing instability in young patients is high, ranging from 47% to 100% in some studies (Rowe, 1956;Henry and Genung, 1982;Hovelius et al, 1983;Wheeler et al, 1989;Hoelen et al, 1990;Marans et al, 1992;Vermeiren et al, 1993;Arciero et al, 1994;Hovelius et al, 1996).…”