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Medical speciality, medication or skills: key factors of prehospital joint reduction. A prospective, multicenter cohort study

  • Georg Siebenbürger
  • Christian Zeckey
  • Julian Fürmetz
  • Wolfgang Böcker
  • Tobias Helfen
Original Article

Abstract

Purpose

Joint dislocations occur frequently in prehospital settings. The medical specialities of emergency physicians are heterogeneous. Decision making and the success rates of reduction attempt can vary greatly. The aim of this prospective multicentre study was to identify the factors most crucial for achieving successful prehospital reduction.

Methods

Study was conducted from 05/2012–05/2015 investigating cases of shoulder, patella and ankle joint dislocations in 16 emergency physician rescue stations. Parameters included: affected joint, type and use of medication, incidence and circumstances of reduction or reduction attempt and medical specialty as well as subjective skill status.

Results

In total 118 patients could be included. Mean age was 40.1 ± 21.3 years. Medical specialties were: n = 61 (51.7%) anaesthesiologists (A), n = 41 (34.5%) surgeons (S), and n = 16 (13.5%) internal medicine/others (I/O). Reduction attempt was performed in n = 97 (82.2%). With taking into account the complexity of the reduction (S) had significantly the highest success rates followed by (A) and (I/O). Regarding the applied medication there was neither a significant correlation between pain (p = 0.161) nor success of reduction (p = 0.09). A higher number of attempts does not improve the success rate (p ≤ 0.001), the pain level was no predictor for success of reduction attempt (p = 0.88).

Conclusion

A successful reduction is determined by the trias of affected joint, skill level and medical specialty of the physician. In each case this trias should be considered by the physician in charge and he must evaluate limitations and circumstances.

Keywords

Joint dislocation Prehospital Shoulder Patella Ankle 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Georg Siebenbürger
    • 1
  • Christian Zeckey
    • 1
  • Julian Fürmetz
    • 1
  • Wolfgang Böcker
    • 1
  • Tobias Helfen
    • 1
  1. 1.Department of General-, Trauma- and Reconstructive SurgeryMunich University HospitalMunichGermany

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