scholarly journals Diagnostic Accuracy of Fresno-Quebec Rules and Risk Factors for an Associated Fracture in Patients Presenting to the Emergency Department with Anterior Shoulder Dislocation: A Retrospective Study

2020 ◽  
Author(s):  
Teoman ATICI
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Retrospective Study ◽  
Diagnostic Accuracy ◽  
Shoulder Dislocation ◽  
Anterior Shoulder Dislocation

scholarly journals Reducing Shoulder by Vertical Traction: A One-Man Method for Shoulder Reduction

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Hayat Ahmad Khan ◽  
Younis Kamal ◽  
Mohammad Ashraf Khan ◽  
Munir Farooq ◽  
Naseemul Gani ◽  
...  
Keyword(s):  
Emergency Department ◽  
Learning Curve ◽  
Shoulder Dislocation ◽  
Anterior Shoulder Dislocation ◽  
Greater Tuberosity ◽  
Traction Method ◽  
Joint Dislocations ◽  
Good Technique ◽  
Recurrent Shoulder Dislocation ◽  
Glenohumeral Dislocation

Fifty percent of joint dislocations reported to the emergency department are of shoulder joint. Various techniques are used to reduce the shoulder and Spaso technique is the least known to the orthopaedic residents which is a simple one-man vertical traction method of shoulder reduction. We evaluated the effectiveness of vertical traction method for anterior shoulder dislocation by orthopaedic residents. Sixty consecutive patients of anterior glenohumeral dislocation attending the emergency department of our hospital were taken up for the study. The reduction was done using Spaso technique. Right shoulder was dislocated in 40 patients and 31 patients had recurrent shoulder dislocation. In 55 patients, shoulder was reduced without the use of any anaesthesia. In patients where no anaesthesia was used, the time of traction ranged from 45 seconds to 5 minutes, while under anaesthesia the time of traction ranged from 1 to 4 minutes. Twenty-one patients had associated greater tuberosity fracture which did not affect the method of reduction and all of them were reducible. No complication was reported, and all the patients were satisfied with the method. In conclusion vertical traction method is a good technique for reducing anterior shoulder dislocation with an easy learning curve among the residents and no complication has been reported so far.

scholarly journals Treatment of first-time traumatic anterior shoulder dislocation: the UK TASH-D cohort study

2019 ◽  
Vol 23 (18) ◽  
pp. 1-104
Author(s):  
Jonathan L Rees ◽  
Anjali Shah ◽  
Katherine Edwards ◽  
Maria T Sanchez-Santos ◽  
Danielle E Robinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Shoulder Dislocation ◽  
Recurrent Dislocation ◽  
Incidence Rates ◽  
Anterior Shoulder Dislocation ◽  
Traumatic Anterior Shoulder Dislocation ◽  
The Uk ◽  
First Time ◽  
Residual Confounding ◽  
Age And Sex

Background Shoulder dislocations are the most common joint dislocations seen in emergency departments. Most traumatic cases are anterior and cause recurrent dislocations. Management options include surgical and conservative treatments. There is a lack of evidence about which method is most effective after the first traumatic anterior shoulder dislocation (TASD). Objectives To produce UK age- and sex-specific incidence rates for TASD. To assess whether or not surgery within 6 months of a first-time TASD decreases re-dislocation rates compared with no surgery. To identify clinical predictors of recurrent dislocation. Design A population-based cohort study of first-time TASD patients in the UK. An initial validation study and subsequent propensity-score-matched analysis to compare re-dislocation rates between surgery and no surgery after a first-time TASD. Prediction modelling was used to identify potential predictors of recurrent dislocation. Setting UK primary and secondary care data. Participants Patients with a first-time TASD between 1997 and 2015. Interventions Stabilisation surgery within 6 months of a first-time TASD (compared with no surgery). Stabilisation surgery within 12 months of a first-time TASD was also carried out as a sensitivity analysis. Main outcome measure Re-dislocation rate up to 2 years after the first TASD. Methods Eligible patients were identified from the Clinical Practice Research Datalink (CPRD) (1997–2015). Accuracy of shoulder dislocation coding was internally validated using the CPRD General Practitioner questionnaire service. UK age- and sex-specific incidence rates for TASD were externally validated against rates from the USA and Canada. A propensity-score-matched analysis using linked CPRD and Hospital Episode Statistics (HES) data compared re-dislocation rates for patients aged 16–35 years, comparing surgery with no surgery. Multivariable Cox regression models for predicting re-dislocation were developed for the surgical and non-surgical cohorts. Results Shoulder dislocation was coded correctly for 89% of cases in the CPRD [95% confidence interval (CI) 83% to 95%], with a ‘primary’ dislocation confirmed for 76% of cases (95% CI 67% to 85%). Far fewer patients than expected received stabilisation surgery within 6 months of a first TASD, leading to an underpowered study. Around 20% of re-dislocation rates were observed for both surgical and non-surgical patients. The sensitivity analysis at 12 months also showed little difference in re-dislocation rates. Missing data on risk factors limited the value of the prediction modelling; however, younger age, epilepsy and sex (male) were identified as statistically significant predictors of re-dislocation. Limitations Far fewer than the expected number of patients had surgery after a first-time TASD, resulting in an underpowered study. This and residual confounding from missing risk factors mean that it is not possible to draw valid conclusions. Conclusions This study provides, for the first time, UK data on the age- and sex-specific incidence rates for TASD. Most TASD occurs in men, but an unexpected increased incidence was observed in women aged > 50 years. Surgery after a first-time TASD is uncommon in the NHS. Re-dislocation rates for patients receiving surgery after their first TASD are higher than previously expected; however, important residual confounding risk factors were not recorded in NHS primary and secondary care databases, thus preventing useful recommendations. Future work The high incidence of TASD justifies investigation into preventative measures for young men participating in contact sports, as well as investigating the risk factors in women aged > 50 years. A randomised controlled trial would account for key confounders missing from CPRD and HES data. A national TASD registry would allow for a more relevant data capture for this patient group. Study registration Independent Scientific Advisory Committee (ISAC) for the Medicines and Healthcare Products Regulatory Agency (ISAC protocol 15_0260). Funding The National Institute for Health Research Health Technology Assessment programme.

Inhaled methoxyflurane for the reduction of acute anterior shoulder dislocation in the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (4) ◽  
pp. 468-472 ◽  
Author(s):  
Etimbuk Umana ◽  
Josephine Hannah Kelliher ◽  
Christiaan Johannes Blom ◽  
Brian McNicholl
Keyword(s):  
Emergency Department ◽  
Shoulder Dislocation ◽  
Recovery Time ◽  
Patient Flow ◽  
Hospital Setting ◽  
Anterior Shoulder Dislocation ◽  
Fracture Dislocations ◽  
Record Review ◽  
The Impact ◽  
Successful Reduction

ABSTRACTObjectivesMethoxyflurane is an inhalation analgesic used in the emergency department (ED) but also has minimal sedative properties. The major aim of this study was to evaluate the success rate of methoxyflurane for acute anterior shoulder dislocation (ASD) reduction. The secondary aim was to assess the impact of methoxyflurane on ED patient flow compared to propofol.MethodsA health record review was performed for all patients presenting with ASD who underwent reduction with either methoxyflurane or propofol over a 13-month period (December 2016 – December 2017). The primary outcome was reduction success for methoxyflurane, while secondary outcomes such as recovery time and ED length of stay (LOS) were also assessed compared to propofol. Patients with fracture dislocations, polytrauma, intravenous, or intramuscular opioids in the pre-hospital setting, no sedation for reduction, and alternative techniques of sedation or analgesia for reduction were excluded.ResultsA total of 151 patients presented with ASD during the study period. Eighty-two patients fulfilled our inclusion criteria. Fifty-two patients had ASD reduction with propofol while 30 patients had methoxyflurane. Successful reduction was achieved in 80% (95% CI 65.69% to 94.31%) patients who used methoxyflurane. The median recovery time and ED LOS were 30 minutes [19.3-44] and 70.5 minutes [49.3-105], which was found to be shorter for the methoxyflurane group, who had successful reductions compared to sedation with propofol.ConclusionMethoxyflurane was used successfully in 30% of the 82 patients undergoing reduction for ASD, while potentially improving ED efficiency.

Full recovery from a potentially lethal dose of orphenadrine ingestion using conservative treatment: A case report

2010 ◽  
Vol 29 (11) ◽  
pp. 961-963 ◽  
Author(s):  
Yan-Chiao Mao ◽  
Dong-Zong Hung ◽  
Chen-Chang Yang ◽  
Jiaan-Der Wang
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Conservative Treatment ◽  
Clinical Features ◽  
Shoulder Dislocation ◽  
Lethal Dose ◽  
Hemodynamic Instability ◽  
Toxic Effects ◽  
Anterior Shoulder Dislocation ◽  
Anticholinergic Effects

Intoxication by orphenadrine is uncommon. The clinical features consist of both central and peripheral anticholinergic effects. Ingestion of 2 to 3 g orphenadrine in an adult has been associated with fatality. A 46-year-old female was brought to our emergency department 1.5 hours after ingesting 40 tablets of 100 mg orphenadrine. She became stuporous 3 hours post-ingestion and developed generalized convulsions 1 hour later. Fifty-five hours post-ingestion, she had recovered and was found to have anterior shoulder dislocation. In addition, severe rhabdomyolysis and persistent nausea were observed. All of the above-noted toxic effects resolved with conservative treatment. Although orphenadrine intoxication can cause convulsions and hemodynamic instability, there is no available antidote and treatment remains supportive.

Diagnostic Accuracy of Ultrasonographic Examination in the Management of Shoulder Dislocation in the Emergency Department

2013 ◽  
Vol 62 (2) ◽  
pp. 170-175 ◽  
Author(s):  
Saeed Abbasi ◽  
Hooshyar Molaie ◽  
Peyman Hafezimoghadam ◽  
Mohammad Amin Zare ◽  
Mohsen Abbasi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Shoulder Dislocation ◽  
Ultrasonographic Examination

scholarly journals A Comparison of Emergency Department Admission Diagnoses and Discharge Diagnoses: Retrospective Study

2003 ◽  
Vol 10 (2) ◽  
pp. 70-75 ◽  
Author(s):  
HS Chiu ◽  
KF Chan ◽  
CH Chung ◽  
K Ma ◽  
KW Au
Keyword(s):  
Emergency Department ◽  
Young Adults ◽  
Retrospective Study ◽  
Diagnostic Accuracy ◽  
Diagnostic Tools ◽  
Admission Diagnosis ◽  
Discharge Diagnosis ◽  
Emergency Department Admission ◽  
Hospital Discharge Diagnosis ◽  
Male Sex

Objective To study the accuracy of emergency department admission diagnosis and the effect of investigations on diagnostic accuracy. Design Retrospective study in a two-month period. Setting Accident & Emergency Department of a public general hospital, which had four in-patient specialties – Medicine, Surgery, Paediatrics and Orthopaedics. Subjects All cases admitted through the emergency department in the study period. Main outcome measures Degree of correlation between emergency department admission diagnosis and hospital discharge diagnosis. Results Of all admission diagnoses, 71.4% fully or partially matched the final discharge diagnoses. The accuracy of diagnosis was statistically better in traumatic cases, the male sex and young adults. Diagnostic accuracy varied with the specialty involved and investigations taken. Conclusion History and physical examination remained the most important diagnostic tools in the emergency department. In general, simple investigations available at the emergency department were not helpful in improving diagnostic accuracy.

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