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J Shoulder Elbow Surg. 2012 Dec;21(12):1706-11. doi: 10.1016/j.jse.2012.04.004. Epub 2012 Jul 21.

Closed reduction techniques in acute anterior shoulder dislocation: modified Milch technique compared with traction-countertraction technique.

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1
Orthopaedic Department, University of Malaya, Kuala Lumpur, Malaysia.

Abstract

BACKGROUND:

To perform closed manual reduction of acute anterior shoulder dislocation using the traction-countertraction technique requires sedation (TCTS) and the participation of 2 people. We studied the modified Milch (MM) technique, a positional reductive maneuver that requires 1 operator, without patient sedation or analgesia.

MATERIALS AND METHODS:

The study comprised 56 prospective nonrandomized consecutive patients, of whom 31 were in group A (MM, nonsedated) and 25 in group B (TCTS).

RESULTS:

The success rate of MM technique was 83.9% (26 of 31), which increased to 96.3% (26 of 27) when 4 patients with associated greater tuberosity fractures were excluded. The success rate was 100% in the TCTS group, with 5 patients with associated greater tuberosity fractures. The reduction in pain from the preprocedural to intraprocedural phases in MM group was significant (P < .001), at a reduction rate of 2.07 (29%) on the numeric rating scale pain score. There was a greater pain reduction rate of 2.43 (34%) on the numeric rating scale when patients with greater tuberosity fractures were excluded. The MM group had a significantly shorter hospital stay (mean, 35 minutes) than the TCTS group (mean, 4 hours). No postreduction neurovascular or fracture complications occurred in either group.

CONCLUSIONS:

The results showed that the Milch technique was effective, safe, shortened hospital stay, and was well tolerated. We recommend the modified Milch technique as a first-line maneuver for acute anterior shoulder dislocations without associated fractures.

PMID:
22819577
DOI:
10.1016/j.jse.2012.04.004
[Indexed for MEDLINE]
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