Incidence and risk factors of unsuccessful closed reduction of anterior shoulder dislocation in emergency department, Chiangrai Prachanukroh Hospital
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Abstract
BACKGROUND: Anterior shoulder dislocation is a common type of shoulder injury, with closed reduction treatment posing risks of complications upon repeated attempts. Identifying risk factors for unsuccessful shoulder reduction is imperative to mitigate medication side effects, hospitalization rates, and emergency room utilization.
OBJECTIVE: To identify the incidence and risk factors for unsuccessful anterior shoulder dislocation reduction in the emergency room.
METHODS: A retrospective cohort study was conducted, collecting data from medical records between January 1, 2018, and December 31, 2022. Data analysis utilized descriptive statistics, t-tests, fisher’s exact test, univariable risk regression analysis and multivariable risk regression analysis.
RESULTS: Of 230 patients with anterior shoulder dislocation revealed an incidence of 19.13% for unsuccessful reduction. Risk factors included concomitant shoulder fracture (adjusted risk ratio: 1.88, 95% CI 0.96-3.69, p=0.027), and prior unsuccessful shoulder reduction attempts at other hospitals (adjusted risk ratio: 2.42, 95% CI 1.412-4.13, p=0.002). The success rate of repeat closed reducing anterior shoulder dislocations second or third times was 64%.
CONCLUSIONS AND RECOMMENDATIONS: Consider reducing an anterior shoulder dislocation a second or third time; otherwise, consult a more experienced doctor if the initial attempted reduction is unsuccessful. Patients with shoulder fractures accompanying shoulder dislocation should undergo specialist evaluation for radiographic assessment, followed by consideration of shoulder reduction under anesthesia in the operating room.
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