Survey on the management of acute first-time anterior shoulder dislocation amongst Dutch public hospitals

Abstract

IntroductionThe primary aim of this study was to record how orthopaedic surgeons are currently managing acute first-time anterior shoulder dislocation (AFASD) 8 years after introduction of the Dutch national guideline: “acute primary shoulder dislocation, diagnostics and treatment” in 2005. The second aim was to evaluate how these surgeons treat recurrent instability after AFASD.Materials and methodsAn online questionnaire regarding the management of AFASD and recurrent shoulder instability was held amongst orthopaedic surgeons of all 98 Dutch hospitals.ResultsThe overall response rate was 60 %. Of the respondents, 75 % had a local protocol for managing AFASD, of which 28 % had made changes in their treatment protocol after the introduction of the national guideline. The current survey showed wide variety in the overall treatment policies for AFASD. Twenty-seven percent of the orthopaedic surgeons were currently unaware of the national guideline. The variability in treatment for AFASD was present throughout the whole treatment from which policy at the emergency department; when to operate for recurrent instability; type of surgical technique for stabilization and type of fixation of the labrum. As for the treatment of recurrent instability, the same variability was seen: 36 % of the surgeons perform only arthroscopic procedures, 7 % only open and 57 % perform both open and arthroscopic procedures.ConclusionsDespite the introduction of the national guideline for the initial management of AFASD in 2005, still great variety among orthopaedic surgeons in the Netherlands was present. As for the surgical stabilization technique, the vast majority of the respondents are performing an arthroscopic shoulder stabilization procedure at the expense of the more traditional open procedure as a first treatment option for post-traumatic shoulder instability.Electronic supplementary materialThe online version of this article (doi:10.1007/s00402-015-2156-3) contains supplementary material, which is available to authorized users.

Mid-term to long-term results of primary arthroscopic Bankart repair for traumatic anterior shoulder instability: a retrospective study

“…Various open and arthroscopic techniques have been developed overtime to address the glenohumeral joint instability with the ultimate goal of restoring the shoulder function and lowering the rate of recurrent instability over the long-term. Bankart repair is currently the treatment of choice according to various surveys of surgeons, with > 90% of surgeons choosing the Bankart procedure as initial repair procedure [3,4,14]. A review of the American Board of Orthopaedic Surgery revealed a significant increase in the percentage of arthroscopicallyperformed Bankart repairs was noted, being performed in approximately 88% of cases between 2006 and 2008, compared to 71% in the period from 2003 to 2005 [35].…”

“…Methods: A total of 100 patients were primarily operated using arthroscopic Bankart repair after traumatic anterior shoulder instability. Medical records were retrospectively reviewed, and patients were assessed using postal questionnaire after a mean follow-up of 8.3 years [3][4][5][6][7][8][9][10][11][12][13][14]. Clinical assessment was performed using Constant score, Rowe score, and American Shoulder and Elbow Surgeons score.…”

The Epidemiology and Natural History of Anterior Shoulder Instability

“…While the indications for operative intervention in young, active, males with first-time Fig. 7 a, b Clinical photographs of a patient wearing an external rotation immobilizer dislocations are expanding and becoming more common [66,67], there still remains a significant role for nonoperative treatment in older individuals, noncontact athletes, lower-demand populations, individuals who present with significant losses in range of motion, in-season athletes, patients with ligamentous laxity, and individuals who cannot tolerate general anesthesia. Physical therapy is critical to shoulder stability through the recruitment and maintenance of dynamic stabilizers and scapulothoracic musculature-subscapularis, supraspinatus, infraspinatus, teres minor, teres major, biceps brachii, trapezius, and deltoid muscles.…”

Management of the First-time Traumatic Anterior Shoulder Dislocation

“…In patients with first-time traumatic anterior shoulder dislocation, if a fracture requiring rigid fixation, such as greater tuberosity fracture with displacement >5 mm 59) or glenoid fracture with bone loss >20% of the glenoid diameter [51][52][53][54] is not accompanied, the initial treatment should be focused on early closed reduction, immobilization, and physical therapy with the goal to restore motion and strength. Riccio et al 60) suggested effective rehabilitative approach as the conservative management in adults with first episode of traumatic anterior shoulder disloca-tion.…”