When is it safe to reduce fracture dislocation of shoulder under sedation? Proposed treatment algorithm

Wronka, Konrad Sebastian; Ved, A.; Mohanty, Khitish

doi:10.1007/s00590-016-1899-z

Cited by 21 publications

(21 citation statements)

References 11 publications

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“…Research shows that iatrogenic fractures occur in about 80% of elderly women due to age-related elements such as postmenopausal osteoporosis [2,13]. In the course of diagnosis and treatment, the neglect of these characteristics of senile shoulder dislocation will lead to serious complications [14].…”

Section: Discussionmentioning

confidence: 99%

“…In present study, we recommend unconscious sedation and GA during closed reduction, which could reduce traction strength, facilitate reduction, and decrease iatrogenic fractures. We believe that the causes of iatrogenic injuries in these patients are mainly related to the following factors: (1) the doctors lacked sufficient understanding of the high-risk population of anterior shoulder dislocation, (2) inadequate imaging examination resulted in the failure to determine the presence of occult anatomical neck fracture before reduction, (3) improper treatment (i.e., without any anesthetic measures, hastily manual reduction without diagnosis, or rough manipulations).…”

Section: Discussionmentioning

confidence: 99%

“…This study is a retrospective case series with prospectively gathered data from January 2014 to June 2017 in our institution, and the inclusion criteria were as follows: (1) eighteen years or older; (2) diagnosis of simple shoulder dislocation or shoulder dislocation with greater tuberosity fracture (GTF), and radiographs of GTF were classified Type 11-A1 according to the Orthopaedic Trauma Association (OTA) classification, and as 1-part or 2-part GTF with shoulder dislocation according to the Neer classification [9] (Fig. 1a (Fig.…”

Section: Participantsmentioning

confidence: 99%

“…Given the incomplete examination before reduction or improper manual reduction by junior residents of the orthopedic department, original occult fractures are displaced. When effective anesthesia is not 3 properly given during reduction, especially in elderly patients with osteoporosis, forced reduction likely causes new fractures or displacement of existing occult fractures, and eventually iatrogenic proximal humeral fractures occur [2,3]. At present, most scholars believe that the causes of such complications are closely related to repeated rough manual reduction without pain relief and muscle relaxation [4,5].…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and management of iatrogenic proximal humeral fracture during manual reduction of shoulder dislocation

Zhou

Jiang

Liu

2019

Preprint

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Purpose This study aimed to investigate the characteristics, management and patient outcomes of iatrogenic proximal humeral fracture during manual reduction of shoulder dislocation. Methods A retrospective chart review from January 2014 to June 2017 identified 10 patients of iatrogenic proximal humeral fracture during shoulder dislocation reduction. The sex and age of patients, associated injuries and location, first-time or habitual shoulder dislocation, the type of anesthesia, the time from injury to revision surgery as well as functional outcomes were analyzed. Results There were 1 male and 9 females (female/male ratio 9:1) with an average age of 66.9 years (range, 50-77 years). All patients presented with first-time anterior shoulder dislocation, and 7 patients (70%) associated with greater tuberosity fractures (GTF). Four patients (40%) underwent reduction under general anesthesia and 6 reduction (60%) under propofol sedation. The revision surgery was performed by open reduction and internal fixation. The mean follow-up period was 18.2 months (range, 12–36 months). The mean visual analog score (VAS) was 3.0 ± 1.6 (range, 1-6), and the mean Neer scores were 82.1 ± 6.5 (range, 71-93). Significant differences were observed in the Neer score and VAS with the time (more or less 8 h) from injury to revision surgery (P < 0.05). Conclusion A high risk of iatrogenic proximal humeral fracture is present in first-time anterior shoulder dislocation with GTF in senile female. Effective reduction and internal fixation performed timely may help to improve functional outcomes in case of iatrogenic injury.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Participantsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Characteristics and management of iatrogenic proximal humeral fracture during manual reduction of shoulder dislocation

Zhou

Jiang

Liu

2019

Preprint

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“…Из 73 человек 36 (49,3%) получили повреждение в результате высокоэнергетической травмы, 35 человек, трехфрагментарные -20 (62,5%), четырехфрагментарные -2 (6,2%).…”

Section: пациентыunclassified

Surgical Treatment of Humerus Fracture-Dislocations: Medium-Term Results

Егиазарян

Ратьев

Ershov

et al. 2020

Traumatology and Orthopedics of Russia

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Background. Fracture-dislocation of the proximal humerus is a severe injury that equally affects both young and old people. Such injuries are often accompanied by the high risk of neurocirculatory and other complications, which defines their great medical and social importance. The purposes of this study were: 1) to compare the mid-term results of the surgical treatment of the patients with dislocation-fractures of the proximal humerus when they were managed according to the standard algorithm or the new one developed by the authors of this study; 2) to evaluate the effectiveness of the proposed protocol in relation to the patients with neurological complications in order to elaborate a universal approach to the optimal treatment tactics. Patients and Methods. The treatment results of 73 patients with proximal humerus fracture-dislocation undergone the surgery from 2012 to 2018. The patients were divided into 2 groups, which were managed according to the traditional (control group) or the new algorithms (main group), differing in the time of the surgery, a set of diagnostic methods, and an approach to the prevention and treatment of complications. The patients’ examination included taking patients’ anamnesis, their physical examination, X-rays and multispiral computed tomography of the injured shoulder, electromyoneurography, ultrasound of the upper limb blood vessels, patients’ questioning. Results. A year after the surgery, a statistically significant difference in the functional results was revealed in the patients of the main and control groups by the Constant Shoulder Score (p = 0.0063). In the control group, there was a statistically significant difference of the functional results by Constant Shoulder Score between the patients with and without neurological complications (p = 0.003). There was no statistically significant difference among such patients in the main group (p = 0.387). Conclusion. The main group patients, including those with neurological complications, achieved higher functional results in comparison with the control group. Thus, the authors’ treatment algorithm showed its effectiveness. The surgery within 6 hours from the moment of admission of the patients with humerus fracture-dislocation, as well as the earliest possible diagnosis of neurological injury and treatment of complications significantly improved the prognosis and outcome the main group patients.

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Success rate of anterior shoulder dislocation reduction by emergency physicians: a retrospective cohort study

Hayashi

Tanizaki

Nishida

et al. 2022

Acute Medicine & Surgery

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Aim Emergency physicians (EPs) often treat anterior shoulder dislocation, but epidemiology of anterior shoulder dislocation in the emergency department of Japan remains unclear. In this study, we clarified the success rate of anterior shoulder reduction performed by EPs. Methods This single‐center cohort study included patients with anterior shoulder dislocation for whom the EP performed initial reduction. The period was from January 2006 to March 2021 and we used the electronic medical record data of the tertiary care hospital. Our primary outcome was the success rate of the shoulder reduction performed by EP. The secondary outcome was to compare the success of reduction with the failure of the reduction. Results In total, 293 eligible patients were identified. Of these patients, 244 were included in this study. The success rate of the shoulder reduction performed by EP was 92.2% (225/244). EPs failed in successfully performing reduction in 19 (7.8%) cases of anterior shoulder dislocations. The failure group was older ( P = 0.017), had a higher frequency of fall down in the mechanism of dislocation ( P = 0.019), used intravenous analgesics more frequently ( P = 0.004), used peripheral nerve blocks more frequently ( P = 0.006), and had fewer patients who did not use drugs ( P = 0.002). We could not perform statical adjustment because the sample size was small. Conclusion The success rate of the shoulder reduction performed by EPs was 92.2%. Older age might be associated with failure of shoulder reduction.

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When is it safe to reduce fracture dislocation of shoulder under sedation? Proposed treatment algorithm

Cited by 21 publications

References 11 publications

Characteristics and management of iatrogenic proximal humeral fracture during manual reduction of shoulder dislocation

Characteristics and management of iatrogenic proximal humeral fracture during manual reduction of shoulder dislocation

Surgical Treatment of Humerus Fracture-Dislocations: Medium-Term Results

Success rate of anterior shoulder dislocation reduction by emergency physicians: a retrospective cohort study

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