Comparison of the efficacy of repositioning anterior shoulder dislocations

Acute anterior shoulder dislocation is more common in trauma orthopedics. The management of acute shoulder dislocation begins with timely repositioning of the dislocated joint. There are many methods for shoulder dislocation, and the classic methods include Hippocrates method, Kocher method, Stimpson method, and Milch method, etc. New methods reported in recent years include FARES (Fast, Reliable, and Enduring). Newer methods reported in recent years include the FARES (fast, reliable, and safe) method and the Eachempati external rotation method. These two new methods are safe, effective, reliable, fast, comfortable, and less painful than traditional repositioning methods. Recently, a prospective randomized controlled study was conducted in India on these two methods of shoulder repositioning and the findings were published in the recent issue of Injury. Patients with acute shoulder dislocation were selected from January 2010 to October 2011 at the level I trauma center of the researcher’s institute. All the patients were diagnosed with shoulder dislocation after imaging and clinical symptoms, and physical examination. Inclusion criteria: 1. Age greater than 18 years old; 2. Shoulder dislocation time less than 24 hours; 3. No previous history of shoulder dislocation; 4. Not taking painkillers, muscarinic and other related therapeutic drugs prior to the hospital visit; 5. The patient is conscious and can cooperate; patients with more serious fractures, such as NEER3 or 4-part fracture, glenoid fracture, etc., or combined with larger traumas are not included in the study. trauma, etc. were not included in the study. A total of 160 patients met the study inclusion criteria (Table 1). After the patients presented to the hospital and the diagnosis of shoulder dislocation was confirmed the patients were randomly assigned into the FARES group and the Eachempati group with a total of 80 patients in each group. Table 1: Demographics of the experimental population The following experimental data were recorded: 1. VAS pain score index (0-100); 2. Time interval between dislocation and the first initiation of repositioning; 3. Time taken from the initiation of repositioning to the time after successful repositioning; 4. Number of attempts to complete the repositioning; and 5. Complications after repositioning. FARES reset technique: the patient lies supine, the resetter stands with the affected side, holds the wrist of the affected limb with both hands, keeps the patient’s elbow joint in a straight state, applies axial traction to the dislocated limb, and gradually abducts the affected limb during the traction process. In the process of axial traction and adduction of the affected limb, the affected limb was shaken repeatedly along the coronal plane of the body with a shaking frequency of 2-3 times per second and a movement amplitude of about 5cm. When shoulder abduction reaches 90 degrees, the affected limb is externally rotated during continuous traction and rocking. The shoulder dislocation is reset when shoulder abduction reaches 120 degrees. Once the shoulder dislocation is confirmed, the reset limb is internally retracted, and the forearm is internally rotated and placed on top of the chest wall for confirmation. The patient lies supine, the resurfacer stands with the affected side, holds the wrist of the affected limb with both hands, keeps the patient’s elbow joint in a state of straightening, applies axial traction to the dislocated affected limb, and gradually abducts the affected limb in the process of traction. In the process of axial traction and abduction of the affected limb, shake the affected limb repeatedly along the coronal plane of the body at a frequency of 2-3 times per second, with a range of movement of about 5 cm. When the shoulder joint is abducted to 90 degrees, continue to traction and shake the affected limb to externally rotate the affected limb. When the shoulder joint is abducted to 120 degrees, the shoulder joint subluxation is reset. Once the shoulder joint subluxation is determined to be reset, the reset limb is internally retracted, and the forearm is internally rotated. The Eachempati external rotation technique: the patient lies supine, the repositioner stands on the affected side, holds the patient’s wrist with one hand and the elbow with the other, keeping the elbow in 90 degrees of flexion and the shoulder in 20 degrees of forward flexion, and pressing the elbow against the lateral chest wall (Fig. 5). Using the shoulder joint as the fulcrum and the upper arm as the axis of rotation, rotate the wrist so that the plane formed by the forearm and upper arm is parallel to the patient’s coronal plane (Figure 6). Care should be taken during external rotation to avoid fractures and other related complications from transitional violence. Figure 5-6 The patient lies supine, the resetter stands with the affected side, holds the patient’s wrist with one hand and the elbow joint with the other hand, keeps the elbow joint flexed at 90 degrees, the shoulder joint is flexed forward at 20 degrees, and keeps the elbow joint close to the lateral chest wall Taking the shoulder joint as a fulcrum and the upper arm as the axis of rotation, rotate the wrist so that the plane composed of the forearm and the upper arm is parallel to the patient’s coronal plane (Fig. 6) Results of the inter-group comparison between the two groups: FARES reset method success rate 76/80 (95%), Eachempati external rotation method success rate 73/80 (91.25%), there was no statistically significant difference in the comparison between the groups (p=0.53); while the comparison of reset speed, pain during reset, and number of times of reset, the FARES method was significantly better than the Eachempati method (Table 2).