Reduction of Acute Anterior Inferior Glenohumeral Joint Dislocation in the Argentine Health Care System. A National Perspective
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Published:
Aug 31, 2022
Keywords:
Anteroinferior glenohumeral dislocation, reduction, anesthesia, complications
Main Article Content
Abstract
Objective: To know the methods used for the initial treatment of the first episode of acute anterior inferior glenohumeral dislocation and to compare the behaviors of physicians between the different levels of specialization. Our hypothesis was that there is great variability in the methods used in Argentina.
Materials and Methods: A survey was conducted using the Google forms platform. It was disseminated through the morbidity and mortality committee of the AAOT and the Argentinian Association of Shoulder and Elbow Surgery. The questionnaire consisted of 13 questions with multiple choice answers that included the degree of specialization, work environment, maneuvers, anesthesia, complications, position, and immobilization time.
Results: 429 complete answers were obtained. 52.2% use the Kocher maneuver as their first choice, followed by the Hippocratic method (15.9%). 72% do not use anesthesia to perform the reduction, there is a statistically significant difference between the use of anesthesia and the different levels of specialization (P= 0.046). 85.8% of the 120 surgeons who use anesthesia for the reduction, use general anesthesia or sedation. 74.8% immobilize the patient in adduction and internal rotation. 13.8% reported having complications related to the reduction.
Conclusions: There is a great variability regarding the methods used to reduce a first episode of LGHAI in the emergency services in Argentina. We believe it is important to reconsider the use of anesthesia, proposing intra-articular anesthesia as the first option, if needed.
Materials and Methods: A survey was conducted using the Google forms platform. It was disseminated through the morbidity and mortality committee of the AAOT and the Argentinian Association of Shoulder and Elbow Surgery. The questionnaire consisted of 13 questions with multiple choice answers that included the degree of specialization, work environment, maneuvers, anesthesia, complications, position, and immobilization time.
Results: 429 complete answers were obtained. 52.2% use the Kocher maneuver as their first choice, followed by the Hippocratic method (15.9%). 72% do not use anesthesia to perform the reduction, there is a statistically significant difference between the use of anesthesia and the different levels of specialization (P= 0.046). 85.8% of the 120 surgeons who use anesthesia for the reduction, use general anesthesia or sedation. 74.8% immobilize the patient in adduction and internal rotation. 13.8% reported having complications related to the reduction.
Conclusions: There is a great variability regarding the methods used to reduce a first episode of LGHAI in the emergency services in Argentina. We believe it is important to reconsider the use of anesthesia, proposing intra-articular anesthesia as the first option, if needed.
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How to Cite
Argüelles, S., Anchundia, J., Chele, A., Holc, F., & David, J. (2022). Reduction of Acute Anterior Inferior Glenohumeral Joint Dislocation in the Argentine Health Care System. A National Perspective. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(4), 498-506. https://doi.org/10.15417/issn.1852-7434.2022.87.4.1554
Section
Clinical Research
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References
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5. Kosnik J, Shamsa F, Raphael E, Huang R, Malachias Z, Georgiadis GM. Anesthetic methods for reduction of acute shoulder dislocations: a prospective randomized study comparing intraarticular lidocaine with intravenous analgesia and sedation. Am J Emerg Med 1999;17(6):566-70. https://doi.org/10.1016/s0735-6757(99)90197-3
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10. Amar E, Maman E, Khashan M, Kauffman E, Rath E, Chechik O. Milch versus Stimson technique for nonsedated reduction of anterior shoulder dislocation: a prospective randomized trial and analysis of factors affecting success. J Shoulder Elbow Surg 2012;21(11):1443-9. https://doi.org/10.1016/j.jse.2012.01.004
11. Christofi T, Kallis A, Raptis DA, Rowland M, Ryan J. Management of shoulder dislocations. Traumatology 2007;
9(1):39-46. https://doi.org/10.1177/1460408607083962
12. Ghane M-R, Hoseini S-H, Javadzadeh H-R, Mahmoudi S, Saburi A. Comparison between traction-countertraction and modified scapular manipulation for reduction of shoulder dislocation. Chin J Traumatol 2014;17(2):93-8. PMID: 24698578
13. Guler O, Ekinci S, Akyildiz F, Tirmik U, Cakmak S, Ugras A, et al. Comparison of four different reduction methods for anterior dislocation of the shoulder. J Orthop Surg Res 2015;10:80. https://doi.org/10.1186/s13018-015-0226-4
14. Singh S, Yong CK, Mariapan S. Closed reduction techniques in acute anterior shoulder dislocation: modified Milch technique compared with traction-countertraction technique. J Shoulder Elbow Surg 2012;21(12):1706-11.
https://doi.org/10.1016/j.jse.2012.04.004
15. Beattie TF, Steedman DJ, McGowan A, Robertson CE. A comparison of the Milch and Kocher techniques for acute anterior dislocation of the shoulder. Injury 1986;17(5):349-52. https://doi.org/10.1016/0020-1383(86)90161-0
16. Alkaduhimi H, van der Linde JA, Willigenburg NW, van Deurzen DFP, van den Bekerom MPJ. A systematic
comparison of the closed shoulder reduction techniques. Arch Orthop Trauma Surg 2017;137(5):589-99.
https://doi.org/10.1007/s00402-017-2648-4
17. Kiviluoto O, Pasila M, Jaroma H, Sundholm A. Immobilization after primary dislocation of the shoulder. Acta
Orthop Scand 1980;51(6):915-9. https://doi.org/10.3109/17453678008990894
18. Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J. Primary anterior dislocation of the
shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am 1996;78(11):1677-84.
https://doi.org/10.2106/00004623-199611000-00006
19. Heidari K, Asadollahi S, Vafaee R, Barfehei A, Kamalifar H, Chaboksavar ZA, et al. Immobilization in external
rotation combined with abduction reduces the risk of recurrence after primary anterior shoulder dislocation. J
Shoulder Elbow Surg 2014;23(6):759-66. https://doi.org/10.1016/j.jse.2014.01.018
20. Itoi E, Hatakeyama Y, Sato T, Kido T, Minagawa H, Yamamoto N, et al. Immobilization in external rotation
after shoulder dislocation reduces the risk of recurrence. A randomized controlled trial. J Bone Joint Surg Am
2007;89(10):2124-31. https://doi.org/10.2106/JBJS.F.00654
21. Murray J-C, Leclerc A, Balatri A, Pelet S. Immobilization in external rotation after primary shoulder dislocation
reduces the risk of recurrence in young patients. A randomized controlled trial. Orthop Traumatol Surg Res
2020;106(2):217-22. https://doi.org/10.1016/j.otsr.2018.10.007
22. Gutkowska O, Martynkiewicz J, Gosk J. Position of immobilization after first-time traumatic anterior glenohumeral dislocation: A literature review. Med Sci Monit 2017;23:3437-45. https://doi.org/10.12659/msm.901876
23. Matthews DE, Roberts T. Intraarticular lidocaine versus intravenous analgesic for reduction of acute anterior
shoulder dislocations. A prospective randomized study. Am J Sports Med 1995;23(1):54-8. https://doi.org/10.1177/036354659502300109
24. Gleeson AP, Graham CA, Meyer AD. Intra-articular lignocaine versus Entonox for reduction of acute anterior
shoulder dislocation. Injury 1999;30(6):403-5. https://doi.org/10.1016/s0020-1383(99)00105-9
25. Jiang N, Hu Y-J, Zhang K-R, Zhang S, Bin Y. Intra-articular lidocaine versus intravenous analgesia and sedation
for manual closed reduction of acute anterior shoulder dislocation: an updated meta-analysis. J Clin Anesth
2014;26(5):350-9. https://doi.org/10.1016/j.jclinane.2013.12.013
1991;9(2):180-8. https://doi.org/10.1016/0735-6757(91)90187-o
2. Gleeson AP. Anterior glenohumeral dislocations: what to do and how to do it. J Accid Emerg Med 1998;15(1):7-12. https://doi.org/10.1136/emj.15.1.7
3. Smith GCS, Chesser TJS, Packham IN, Crowther MAA. First time traumatic anterior shoulder dislocation: a review of current management. Injury 2013;44(4):406-8. https://doi.org/10.1016/j.injury.2013.01.001
4. te Slaa RL, Wijffels MPJM, Marti RK. Questionnaire reveals variations in the management of acute first time
shoulder dislocations in the Netherlands. Eur J Emerg Med 2003;10(1):58-61. https://doi.org/10.1097/00063110-200303000-00015
5. Kosnik J, Shamsa F, Raphael E, Huang R, Malachias Z, Georgiadis GM. Anesthetic methods for reduction of acute shoulder dislocations: a prospective randomized study comparing intraarticular lidocaine with intravenous analgesia and sedation. Am J Emerg Med 1999;17(6):566-70. https://doi.org/10.1016/s0735-6757(99)90197-3
6. Uglow MG. Kocher’s painless reduction of anterior dislocation of the shoulder: a prospective randomised trial.
Injury 1998;29(2):135-7. https://doi.org/10.1016/s0020-1383(97)00168-x
7. Rezende B da RM, de Almeida JI Sr, de Sousa UJ, Bomfim L de S, Ferreira MS Jr. Glenohumeral dislocation: a
prospective randomized study comparing spazo and kocher maneuvers. Acta Ortop Bras 2015;23(4):192-6.
https://doi.org/10.1590/1413-78522015230400701
8. Sayegh FE, Kenanidis EI, Papavasiliou KA, Potoupnis ME, Kirkos JM, Kapetanos GA. Reduction of acute anterior
dislocations: a prospective randomized study comparing a new technique with the Hippocratic and Kocher methods. J Bone Joint Surg Am 2009;91(12):2775-82. https://doi.org/10.2106/JBJS.H.01434
9. Dala-Ali B, Penna M, McConnell J, Vanhegan I, Cobiella C. Management of acute anterior shoulder dislocation. Br J Sports Med 2014;48(16):1209-15. https://doi.org/10.1136/bjsports-2012-091300
10. Amar E, Maman E, Khashan M, Kauffman E, Rath E, Chechik O. Milch versus Stimson technique for nonsedated reduction of anterior shoulder dislocation: a prospective randomized trial and analysis of factors affecting success. J Shoulder Elbow Surg 2012;21(11):1443-9. https://doi.org/10.1016/j.jse.2012.01.004
11. Christofi T, Kallis A, Raptis DA, Rowland M, Ryan J. Management of shoulder dislocations. Traumatology 2007;
9(1):39-46. https://doi.org/10.1177/1460408607083962
12. Ghane M-R, Hoseini S-H, Javadzadeh H-R, Mahmoudi S, Saburi A. Comparison between traction-countertraction and modified scapular manipulation for reduction of shoulder dislocation. Chin J Traumatol 2014;17(2):93-8. PMID: 24698578
13. Guler O, Ekinci S, Akyildiz F, Tirmik U, Cakmak S, Ugras A, et al. Comparison of four different reduction methods for anterior dislocation of the shoulder. J Orthop Surg Res 2015;10:80. https://doi.org/10.1186/s13018-015-0226-4
14. Singh S, Yong CK, Mariapan S. Closed reduction techniques in acute anterior shoulder dislocation: modified Milch technique compared with traction-countertraction technique. J Shoulder Elbow Surg 2012;21(12):1706-11.
https://doi.org/10.1016/j.jse.2012.04.004
15. Beattie TF, Steedman DJ, McGowan A, Robertson CE. A comparison of the Milch and Kocher techniques for acute anterior dislocation of the shoulder. Injury 1986;17(5):349-52. https://doi.org/10.1016/0020-1383(86)90161-0
16. Alkaduhimi H, van der Linde JA, Willigenburg NW, van Deurzen DFP, van den Bekerom MPJ. A systematic
comparison of the closed shoulder reduction techniques. Arch Orthop Trauma Surg 2017;137(5):589-99.
https://doi.org/10.1007/s00402-017-2648-4
17. Kiviluoto O, Pasila M, Jaroma H, Sundholm A. Immobilization after primary dislocation of the shoulder. Acta
Orthop Scand 1980;51(6):915-9. https://doi.org/10.3109/17453678008990894
18. Hovelius L, Augustini BG, Fredin H, Johansson O, Norlin R, Thorling J. Primary anterior dislocation of the
shoulder in young patients. A ten-year prospective study. J Bone Joint Surg Am 1996;78(11):1677-84.
https://doi.org/10.2106/00004623-199611000-00006
19. Heidari K, Asadollahi S, Vafaee R, Barfehei A, Kamalifar H, Chaboksavar ZA, et al. Immobilization in external
rotation combined with abduction reduces the risk of recurrence after primary anterior shoulder dislocation. J
Shoulder Elbow Surg 2014;23(6):759-66. https://doi.org/10.1016/j.jse.2014.01.018
20. Itoi E, Hatakeyama Y, Sato T, Kido T, Minagawa H, Yamamoto N, et al. Immobilization in external rotation
after shoulder dislocation reduces the risk of recurrence. A randomized controlled trial. J Bone Joint Surg Am
2007;89(10):2124-31. https://doi.org/10.2106/JBJS.F.00654
21. Murray J-C, Leclerc A, Balatri A, Pelet S. Immobilization in external rotation after primary shoulder dislocation
reduces the risk of recurrence in young patients. A randomized controlled trial. Orthop Traumatol Surg Res
2020;106(2):217-22. https://doi.org/10.1016/j.otsr.2018.10.007
22. Gutkowska O, Martynkiewicz J, Gosk J. Position of immobilization after first-time traumatic anterior glenohumeral dislocation: A literature review. Med Sci Monit 2017;23:3437-45. https://doi.org/10.12659/msm.901876
23. Matthews DE, Roberts T. Intraarticular lidocaine versus intravenous analgesic for reduction of acute anterior
shoulder dislocations. A prospective randomized study. Am J Sports Med 1995;23(1):54-8. https://doi.org/10.1177/036354659502300109
24. Gleeson AP, Graham CA, Meyer AD. Intra-articular lignocaine versus Entonox for reduction of acute anterior
shoulder dislocation. Injury 1999;30(6):403-5. https://doi.org/10.1016/s0020-1383(99)00105-9
25. Jiang N, Hu Y-J, Zhang K-R, Zhang S, Bin Y. Intra-articular lidocaine versus intravenous analgesia and sedation
for manual closed reduction of acute anterior shoulder dislocation: an updated meta-analysis. J Clin Anesth
2014;26(5):350-9. https://doi.org/10.1016/j.jclinane.2013.12.013