Which is the most appropriate anterior glenohumeral dislocation reduction technique among three different techniques? A prospective, randomized clinical trial
Ali Batur1, Volkan Arslan1, Muhammet Çağatay Engin2, Şenol Arslan3, Ahmet Köse4
1Department of Emergency Medicine, Hacettepe University, Faculty of Medicine, Ankara, Türkiye
2Department of Orthopedics and Traumatology, Atatürk University, Faculty of Medicine, Erzurum, Türkiye
3Department of Emergency Medicine, Erzurum Regional Training and Research Hospital, Erzurum, Türkiye
4Department of Orthopedics and Traumatology, Erzurum Regional Training and Research Hospital, Erzurum, Türkiye
Keywords: Cunningham, external rotation, glenohumeral dislocation, reduction, shoulder, traction counter traction.
Objectives: This study aims to compare three glenohumeral dislocation (GHD) reduction techniques in terms of pain and reduction time and to offer clinicians an idea of the selection of the most appropriate technique.
Patients and methods: This multi-center, prospective, randomized clinical study included a total of 90 patients (55 males, 35 females; median age: 29 years; range, 22 to 41 years) who had isolated anterior GHD without complication between December 2019 and December 2021. The patients were divided into three equal groups (traction-countertraction [TCT], external rotation [ExR], and Cunningham) using the block randomization method, and reductions were performed. Pre-reduction, intra-reduction, and post-reduction Visual Analog Scale (VAS) scores, reduction times, success rates, and complication rates were analyzed.
Results: There was no statistically significant difference among the groups in terms of age (p=0.414), sex (p=0.954), pre-reduction VAS (p=0.175), and post-reduction VAS (p=0.204). The median intra-reduction VAS values in the TCT, the external rotation, and the Cunningham groups were 8 (range, 7 to 9), 5 (range, 4 to 7), and 4 (range, 2.75 to 5), respectively (p<0.001). The median reduction time and IQR were 105 (range, 82.5 to 120) sec for TCT, 270 (range, 232.5 to 300) sec for ExR, and 630 (range, 540 to 780) sec for Cunningham (p=0.001).
Conclusion: The fastest, but most painful technique is TCT, while the longest and the least painful technique is Cunningham. An inverse relationship is found between time and pain. Based on these findings, it seems to be reasonable to leave the choice of the ideal reduction technique to the clinician. The clinician should choose the technique to be used according to the conditions in the emergency department.
Citation: Batur A, Arslan V, Engin MÇ, Arslan Ş, Köse A. Which is the most appropriate anterior glenohumeral dislocation reduction technique among three different techniques? A prospective, randomized clinical trial. Jt Dis Relat Surg 2023;34(1):144-150. doi: 10.52312/jdrs.2023.879
The study protocol was approved by the Erzurum Regional Training and Research Hospital Ethics Committee (date: 02.12.2019, no: 2019/15-146). The study was conducted in accordance with the principles of the Declaration of Helsinki.
A written informed consent was obtained from each patient.
Data Sharing Statement:
The data that support the findings of this study are available from the corresponding author upon reasonable request.
Idea/concept, design: A,B,, Ş,A,, A,K.; Control/supervision, analysis and/or interpretation: A.B., V.A.; Data Collection and/or processing: A.B., M.Ç.E., A.K., V.A., Ş.A.; Literature review: A.B., V.A., M.Ç.E.; Writing the article: A.B., Ş.A., M.Ç.E.; Critical review: A.B., V.A., Ş.A.; References and fundings: A.B.; Materials: A.B., V.A., Ş.A., M.Ç.E., A.K.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.