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Woyke S, Pawlak J, Cappello TD, Schultheiss G, Mayer H, Witt U, Strapazzon G, Brugger H, Jacob M. Shoulder reduction on the scene: current practice and outcome of the Bavarian Mountain Rescue Service-a prospective observational study. Sci Rep 2023; 13:20212. [PMID: 37980383 PMCID: PMC10657475 DOI: 10.1038/s41598-023-47464-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/14/2023] [Indexed: 11/20/2023] Open
Abstract
Out-of-hospital reduction of shoulder dislocations using the Campell method is recommended by the International Commission for Alpine Rescue and applied in the Bavarian Mountain Rescue Service (Bergwacht Bayern, BWB) protocols. This prospective observational study includes patients out-of-hospital with suspected shoulder dislocation and treated and evacuated by the BWB. Data were systematically collected using three questionnaires: one completed on-site by the rescuer, the second in hospital by the physician and the third within 28 (8-143) days after the accident by the patient. The suspected diagnosis of shoulder dislocation was confirmed in hospital in 37 (84%) of 44 cases. Concomitant injuries in other body regions were found in eight (16%) of 49 cases and were associated with incorrect diagnosis (p = 0.002). Younger age (p = 0.043) and first shoulder dislocation event (p = 0.038) were associated with a higher success rate for reduction attempts. Out-of-hospital reduction of shoulder dislocations leads to significant pain relief and no poorer long-term outcome. Signs that are associated with successful out-of-hospital reduction (younger age and first event), but also those that are associated with incorrect diagnosis (concomitant injuries) should be considered before trying to reduce shoulder dislocation on site. The considerable rate of incorrect first diagnosis on site should give rise to an intensive discussion around teaching and training for this intervention.Trial registration: This study is registered with the German Registry for Clinical Trials (DRKS00023377).
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Affiliation(s)
- Simon Woyke
- Bavarian Mountain Rescue Service, Am Sportpark 6, 83646, Bad Tölz, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Johannes Pawlak
- Bavarian Mountain Rescue Service, Am Sportpark 6, 83646, Bad Tölz, Germany.
- Landesamt für Gesundheit und Lebensmittelsicherheit, Task Force Infectiology, Munich, Germany.
| | - Tomas Dal Cappello
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Georg Schultheiss
- Bavarian Mountain Rescue Service, Am Sportpark 6, 83646, Bad Tölz, Germany
- Department of Anaesthesiology and Intensive Care Medicine, RoMed Clinic Bad Aibling, Bad Aibling, Germany
| | - Herbert Mayer
- Bavarian Mountain Rescue Service, Am Sportpark 6, 83646, Bad Tölz, Germany
- Department of Traumatology and Orthopedic Surgery, Clinic Immenstadt, Immenstadt, Germany
| | - Ulrike Witt
- Bavarian Mountain Rescue Service, Am Sportpark 6, 83646, Bad Tölz, Germany
- Emergency Department, Krankenhaus Agatharied, Hausham, Germany
| | - Giacomo Strapazzon
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - Hermann Brugger
- Department of Anaesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- International Commission for Mountain Emergency Medicine (ICAR MedCom), Zürich, Switzerland
| | - Matthias Jacob
- Bavarian Mountain Rescue Service, Am Sportpark 6, 83646, Bad Tölz, Germany
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Barmherzige Brüder Klinikum St. Elisabeth Straubing GmbH, Straubing, Germany
- Faculty of Medicine, Ludwig Maximilian University, Munich, Germany
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Gottlieb M. Shoulder Dislocations in the Emergency Department: A Comprehensive Review of Reduction Techniques. J Emerg Med 2020; 58:647-666. [PMID: 31917030 DOI: 10.1016/j.jemermed.2019.11.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 01/24/2023]
Abstract
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.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
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