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J Orthop Trauma. 2013 Apr;27(4):190-3. doi: 10.1097/BOT.0b013e31826576f8.

Management of first-time dislocations of the shoulder in patients older than 40 years: the prevalence of iatrogenic fracture.

Author information

1
Reading Shoulder Unit, Royal Berkshire Hospital, Reading, United Kingdom.

Abstract

OBJECTIVE:

To evaluate the prevalence of iatrogenic humeral neck fracture after attempted closed reduction in patients older than 40 years who present with a first-time anterior dislocation.

DESIGN:

Retrospective cohort study, evidence-based medicine level IV.

PATIENTS:

Ninety-two patients older than 40 years (mean 66.6 years of age) with a first-time anterior dislocation of the shoulder.

INTERVENTION:

Closed reductions by the emergency medicine physicians under conscious sedation, in the emergency department.

MAIN OUTCOME MEASUREMENTS:

Prevalence of iatrogenic fracture on postreduction radiographs.

RESULTS:

Nineteen (20.7%) patients were diagnosed with a concomitant greater tuberosity fracture on initial radiograph. In the postreduction radiographs, 5 patients (5.4%) were identified with a postreduction humeral neck fracture, and all of them had a greater tuberosity fracture on initial radiographs. A highly significant association (P < 0.0001) was observed between the finding of a greater tuberosity fracture on the initial radiographs and the occurrence of iatrogenic humeral neck fracture after close reduction.

DISCUSSION:

Previous case reports have described an iatrogenic humeral neck fracture with reduction attempt of shoulder dislocation. In our retrospective study, 21% of the cohort of patients older than 40 years had a concomitant greater tuberosity fracture; 26% of them had an iatrogenic humeral neck fracture after reduction attempt under sedation in the emergency room. These patients ended up with poor outcome.

CONCLUSIONS:

Patients older than 40 years, presenting with a first-time anterior shoulder dislocation with an associated fracture of the greater tuberosity have a significant rate of iatrogenic humeral neck fracture during closed reduction under sedation.

Comment in

PMID:
22810551
DOI:
10.1097/BOT.0b013e31826576f8
[Indexed for MEDLINE]

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