Simple self-reduction method for anterior shoulder dislocation

Shoulder dislocations represent more than 50% of all major joint dislocations and the most frequent type (>90%) of this injury is anterior shoulder dislocation[1-3]. Acute anterior shoulder dislocations usually are orthopaedic emergency cases, where reduction as the most effective pain relief therapy should be performed as soon as possible. The injury mechanisms responsible for anterior shoulder dislocations include axial stress on the arm in a position of forced abduction and external rotation, all on the arm in retroversion, or direct force injuries. Most of the reduction techniques are based on the principle of traction and countertraction[3-7]. These techniques, such as Hippocrates method or the methods described by Matsen or Mane[3,4], usually require adequate analgesia for muscle relaxation. They are tainted with possible iatrogenic complications by the damage of the neurovascular brachial structures[8,9]. The Stimson’s method utilizes the force of the gravidity[10]. In a prone position, traction of the affected arm hanging down in forward flexion was carried out using a weight applied to the wrist. Other techniques require manipulation of the affected shoulder using external rotation abduction and traction, such as the technique described by Kocher in supine position[7] as Objective: To demonstrate and evaluate a modified simple method about self-reduction of anterior shoulder dislocation for significance in the emergency room. Methods: The Boss-Holzach-Matter method for self-reduction of anterior shoulder disloaction is described. Patients with an anterior shoulder dislocation were retrospectively analysed concerning age, gender, type of anterior shoulder dislocation, occurrence of associated fractures, time between injury and reduction, reduction time, and method of reduction with its respective success rate. Results: Eighty-six patients (52 men, 34 women, mean age 49 years) were treated from January 2010 to June 2014. The reduction time ranged between 20 seconds and 6 min (mean 1.5 min). Subcoracoid type of shoulder dislocation was seen in 72 cases (84%), subglenoid type in 14 cases (16%). Associated factures were seen in 20 cases, proportionally more often in subgleboid dislocations, 12 at the greater tuberosity, 6 at the inferior rim of the glenoid fossa and 2 at both localizations. The Boss-Holzach-Matter method was used in 35 cases with a success rate of 71.5%; die Kocher method and traction/countertraction method with premedication were used in 14 cases and 17 cases with success rates of 64% and 70%, respectively. All other cases and the failed primary attempts required hyponotic medication. All patients older than 70 (n=16) were not able to perform the self reducing procedure. Conclusion: The presented Boss-Holzach-Matter method for reduction of anterior shoulder dislocation is a simple method without the need of anaesthesia, but cooperation from patients is crucial. The successful rate is comparable with other established methods. Journal of Acute Disease (2014)207-210