Double traction method-an easy and safe reduction method for anterior shoulder dislocations, even for non-orthopedic surgeons

A Systematic Review With Pairwise and Network Meta-analysis of Closed Reduction Methods for Anterior Shoulder Dislocation

STUDY OBJECTIVE

To review closed reduction methods for anterior shoulder dislocation and perform the first comprehensive comparison of the individual methods in terms of success rate, pain, and reduction time.

METHODS

We searched MEDLINE, PubMed, EMBASE, Cochrane, and ClinicalTrials.gov for randomized controlled trials registered until December 31, 2020. We performed a pairwise and network meta-analysis using a Bayesian random-effects model. Two authors independently performed screening and risk-of-bias assessment.

RESULTS

We found 14 studies with 1,189 patients. In a pairwise meta-analysis, no significant difference was found in the only comparable pair, namely, the Kocher method versus the Hippocratic method (success rate: odds ratio, 1.21; 95% confidence interval [CI], 0.53, 2.75: pain during reduction [visual analog scale]: standard mean difference, -0.33; 95% CI, -0.69, 0.02; reduction time [minutes]: mean difference, 0.19, 95% CI, -1.77, 2.15). In network meta-analysis, FARES (Fast, Reliable, and Safe) was the only method significantly less painful than the Kocher method (mean difference, -4.0; 95% credible interval, -7.6, -0.40). In the surface under the cumulative ranking (SUCRA) plot of success rate, FARES, and the Boss-Holzach-Matter/Davos method showed high values. For pain during reduction, FARES had the highest SUCRA value in the overall analysis. In the SUCRA plot of reduction time, modified external rotation and FARES had high values. The only complication was 1 case of fracture with the Kocher method.

CONCLUSION

Overall, Boss-Holzach-Matter/Davos, and FARES demonstrated the most favorable value for success rates, whereas both FARES and modified external rotation were more favorable in reduction times. FARES had the most favorable SUCRA for pain during reduction. Future work directly comparing techniques is needed to better understand the difference in reduction success and complications.

A systematic review of pre-hospital shoulder reduction techniques for anterior shoulder dislocation and the effect on patient return to function

PURPOSE

The majority of acute anterior shoulder dislocations are sustained during sports and wilderness activities. The management of acute dislocations in the pre-hospital setting is currently without guidelines based on the evidence. The study aims to assess the risk of acute complications in pre-hospital shoulder reduction and identify which pre-hospital reduction technique has the highest success rate in the published literature.

METHODS

The involved databases were Allied and Complementary Medicine, CENTRAL, CINAHL, Cochrane Database of Systematic Reviews, Embase, Europe PMC, Ovid MEDLINE®, Pedro, Proquest, Trip, and World Health Organization International Clinical Trials Registry platform. Only original research of high methodological quality was included, which was defined by the recently developed assessment tool-assessing the methodological quality of published papers (AMQPP) and investigated the management of acute anterior shoulder dislocations in the pre-hospital setting.

RESULTS

Two hundred and ninety-eight articles were identified and screened. A full text review was performed on 40 articles. Four articles published between 2015 and 2018 met the inclusion criteria. A total of 181 patients were included with the study duration ranging from 6 to 60 months. All studies reported zero immediate complication following pre-hospital reduction and there were no documented subsequent adverse events regardless of the technique used. Prompt resolution of neurological symptoms was observed following the early and successful pre-hospital reduction. First attempt success rate, when performed by skilled practitioners, ranged from 72.3% to 94.9%.

CONCLUSION

Pre-hospital shoulder reduction appears to be a safe and feasible option when carried out with the appropriate expertise. A novel reduction technique adapted from the mountain medicine diploma course at the University of Paris North was found to have the highest first attempt reduction success rate of 94.9%. Other techniques described in the literature included Hippocratic, Stimson's, Counter-traction and external rotation with the success rates ranging from 54% to 71.7%.

Shoulder Dislocations in the Emergency Department: A Comprehensive Review of Reduction Techniques

BACKGROUND

Shoulder dislocations are a common presentation to the emergency department and one of the most frequent types of joint dislocations. Studies have found that delays from presentation to first reduction attempt and failed attempt at initial reduction are associated with lower rates of overall reduction success.

DISCUSSION

This article reviews 26 total reduction techniques, as well as a variety of modifications to these techniques. Each technique has distinct advantages and limitations associated with its use. While there are limited data comparing specific techniques, the individual success rates of most maneuvers range from 60-100%.

CONCLUSION

It is essential for emergency physicians to be familiar with multiple different reduction techniques in case the initial reduction attempt is unsuccessful or patient-specific characteristics limit the ability to perform certain techniques. This article reviews several reduction maneuvers for shoulder dislocations, variations on these techniques, and advantages and disadvantages for each approach. It is intended to serve as a resource for those interested in expanding their knowledge of shoulder reduction techniques.