Clinical Efficacy Of Manual Reduction With Acromion Fixed And Humeral External Rotation In Treatment Of Anterior Shoulder Dislocation

Part One Manual reduction with acromion fixed and external humeral rotation treating anterior shoulder dislocationObjective: To investigate the clinical efficacy of manual reduction with acromion fixed humeral external rotation in treatment of anterior shoulder dislocation by analyzing the mechanism of shoulder dislocation through CT three-dimensional imaging.Methods:From September 2014 to March 2015,28 patients with closed anterior shoulder dislocation were being treated in our hospital underwent manual reduction with acromion fixed humeral external rotation techniques without anesthesia or sedation.Including 24 males and 4 females,the youngest was 17 years old and oldest of 62 years,mean 37 years;11 cases in left side,17 cases of right side;19 cases of superior side,10 cases of weak side;13 cases of sports injuries,broken hurts 8 cases,traffic accident in 5 cases,2 cases of fall injury.Primary dislocation in 20 cases,8 cases of recurrent dislocation;Subglenoid dislocation 22 cases and 6 cases of subcoracoid dislocation.3 cases combined with humeral greater tuberosity avulsion fracture in.All patients were blunt trauma without brachial plexus injury.The shortest from injury to reduction is 1 hour,the longest of 39 hours,average 3.4 hours,the medians was 1.5 hours.25 patients with simple dislocation were treated with internal fixation of the forearm suspension for 3 weeks.2 cases of 3 with avulsion fracture of the humeral greater tuberosity were treated with transcutaneous hollow nail fixation.1 case of 3 treated with over-shoulder-elbow plaster fixation in the adduction internal rotation position for 4 weeks,functional exercise was done during and after the lifting of fixation.The time from injury to successful reduction,reduction time,residence time in the hospital,cases of complications,VAS pain score preoperative and postoperative were used to assess the efficacy.Neer shoulder score standard was used to evaluate the shoulder function 3 months later.Results:All patients underwent reduction without anesthesia or sedation,the reduction efficiency was 100%.Reset time ranged from 32 s to 110 s,averaged 65 s,the medians was 52s;The residence time in the hospital ranges from 36 min to 148 min,an average of 50min;VAS score preoperative and postoperative averaged 7.5±1.3points,2.6±0.5 points,;Postoperative physical examination confirmed no patient occurred iatrogenic complications such as fractures and brachial plexus injury during reduction.X-rays confirmed satisfactory reduction without fracture complications in all cases.All patients were followed up 4 to 12 months,the medians was 11 months,among with only 1 case of dislocation during strenuous activity again in the follow-up period.Neer score showed excellent in 26 cases and good in 2 cases 3 months later.Conclusion:Manual reduction with acromion fixed humeral external rotation treating shoulder anterior dislocation is tender,safe and high efficient with short reset time.Patients with less pain,lower complications and doctors need little traction force.It’s particularly suitable to the young strong patients,the elderly weak and anesthesia contraindications patients and elderly patients with osteoporosis or hypertension,heart disease,etc.It is worthy of promotion for being in line with shoulder joint anatomy and biomechanical principles.Part Two A prospective randomized study comparing Manual reduction with acromion fixed and external humeral rotation and Hippocrates method in treatment of anterior shoulder dislocationObjective: To investigate and compare the reduction efficiency,reduction time,patient shoulder function,patient pain and complication of manual reduction with acromion fixed and external humeral rotation and Hippocrates method in the treatment of shoulder anterior dislocation,then provide a better choice for the emergency reduction of clinical shoulder dislocation.Methods:From April 2015 to December 2016,a prospective study was conducted on 92 patients with acute shoulder dislocation who met the inclusion criteria in our hospital.Including 76 males and 16 females,the youngest was 16 years old and oldest of 78 years,mean 35 years,the medians was 25 years;30 cases in left side,62 cases of right side;56 cases of superior side,36 cases of weak side;34 cases of sports injuries,broken hurts 18 cases,traffic accident in 22 cases,12 cases of fall injury and others in 6 cases.Primary dislocation in 70 cases,22 cases of recurrent dislocation;Subglenoid dislocation 71 cases and 21 cases of subcoracoid dislocation.8 cases combined with humeral greater tuberosity avulsion fracture in.All patients were blunt trauma without brachial plexus injury.All patients were randomly divided into two groups,the acromion fixation group(45 cases,short for group AFER)or Hippocrates group(43 cases).The reduction time,the number of complications,the reduction efficiency and the time from treatment to reduction were recorded.The patient pain scores before and after the reduction were recorded according to the VAS scoring system.The Neer’s shoulder score were calculated and compared in all the follow-up cases 3 months after reduction.Results:There was no statistically significant difference in age,sex,injury side,dislocation,treatment to reduction time,complication,recurrence rate and Neer score 3 months after reduction between the two groups(P> 0.05).However,the number of complications and the recurrence rate in the AFER group were lower than those of the Hippocrates group.Compared with the Hippocrates group,the AFER group got higher success rate and shorter reset time.The difference was statistically significant(P <0.05).The VAS score before reduction had no significant difference between the two groups(P> 0.05),while the VAS pain score after reduction was statistically significant(P <0.05).Conclusion:Both methods showed good results in the reduction success rate in treating anterior shoulder dislocation,but the AFER method was significantly better than the Hippocrates method.The AFER method is with shorter reduction time and more effective,quick and easy to apply compared with the Hippocrates method,patients with less pain and less complication.