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Closed reduction techniques for acute anterior shoulder dislocation: a systematic review and meta-analysis

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background

Anterior shoulder dislocations are the most common type of joint dislocation with the majority treated with closed reduction. Reduction methods can be grouped into their principle mode of action: traction–countertraction, leverage and scapular manipulation. The best method has yet to be identified and our aim was to find the most effective, safe and least painful method of closed reduction for acute anterior shoulder dislocations.

Methods

A search of the online databases of CENTRAL, MEDLINE and Embase was performed to identify randomised control trials (RCTs) comparing closed reduction methods for anterior shoulder dislocations. A systematic review and meta-analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

Twelve eligible RCTs were included with a total of 1055 patients. Our meta-analysis showed traction–countertraction methods are marginally less painful than leverage methods by 0.86 points on the VAS scale but leverage methods are quicker by 20 s. Amongst traction–countertraction methods, the Spaso technique was the least painful and quickest, albeit with no difference in overall success rate. A meta-analysis was not possible for comparisons involving scapular manipulation due to the paucity of studies, but within two studies, scapular manipulation was significantly less painful than both leverage and traction–countertraction methods by 1.5 and 2.3 points (VAS), respectively.

Conclusion

Traction–countertraction methods are less painful but slower than leverage methods with no difference in complication rates. However, there was no difference in overall reduction success rate between any of the groups.

Level of evidence

I.

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Acknowledgements

We would like to thank Mr Subodh Deshmukh and Mr Raj Thakrar for help with the review protocol and screening of studies.

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Authors and Affiliations

  1. Trauma and Orthopaedic Department, Sandwell & West Birmingham Hospitals NHS Trust, Lyndon, West Bromwich, Birmingham, West Midlands, B71 4HJ, UK

    Huan Dong, Edward A. Jenner & Kanthan Theivendran

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  1. Huan Dong
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  2. Edward A. Jenner
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  3. Kanthan Theivendran
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Correspondence to Huan Dong.

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All authors declare that they have no conflict of interest. The authors can confirm that, to the best of our knowledge, there has been no prior or duplicate submission or publication elsewhere of any part of the work. The manuscript has been read and approved by all authors, and each author believes that the manuscript represents honest work.

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No institutional review board (IRB) or Ethical Committee approval was undertaken as this was not applicable.

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Dong, H., Jenner, E.A. & Theivendran, K. Closed reduction techniques for acute anterior shoulder dislocation: a systematic review and meta-analysis. Eur J Trauma Emerg Surg 47, 407–421 (2021). https://doi.org/10.1007/s00068-020-01427-9

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  • DOI: https://doi.org/10.1007/s00068-020-01427-9

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