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A systematic comparison of the closed shoulder reduction techniques

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

To identify the optimal technique for closed reduction for shoulder instability, based on success rates, reduction time, complication risks, and pain level.

Methods

A PubMed and EMBASE query was performed, screening all relevant literature of closed reduction techniques mentioning the success rate written in English, Dutch, German, and Arabic. Studies with a fracture dislocation or lacking information on success rates for closed reduction techniques were excluded. We used the modified Coleman Methodology Score (CMS) to assess the quality of included studies and excluded studies with a poor methodological quality (CMS < 50). Finally, a meta-analysis was performed on the data from all studies combined.

Results

2099 studies were screened for their title and abstract, of which 217 studies were screened full-text and finally 13 studies were included. These studies included 9 randomized controlled trials, 2 retrospective comparative studies, and 2 prospective non-randomized comparative studies. A combined analysis revealed that the scapular manipulation is the most successful (97%), fastest (1.75 min), and least painful reduction technique (VAS 1,47); the “Fast, Reliable, and Safe” (FARES) method also scores high in terms of successful reduction (92%), reduction time (2.24 min), and intra-reduction pain (VAS 1.59); the traction-countertraction technique is highly successful (95%), but slower (6.05 min) and more painful (VAS 4.75).

Conclusion

For closed reduction of anterior shoulder dislocations, the combined data from the selected studies indicate that scapular manipulation is the most successful and fastest technique, with the shortest mean hospital stay and least pain during reduction. The FARES method seems the best alternative.

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Authors and Affiliations

  1. Shoulder and Elbow Unit, Joint Research, OLVG, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands

    H. Alkaduhimi, J. A. van der Linde, N. W. Willigenburg, D. F. P. van Deurzen & M. P. J. van den Bekerom

Authors
  1. H. Alkaduhimi
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  2. J. A. van der Linde
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  3. N. W. Willigenburg
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  4. D. F. P. van Deurzen
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  5. M. P. J. van den Bekerom
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The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

Appendix 1

Appendix 1

Pubmed search

(reduct* OR reposit*) AND shoulder AND (dislocat* OR instabil*).

Embase search

(reduct* OR reposit*) AND shoulder AND (dislocat* OR instabil*).

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Alkaduhimi, H., van der Linde, J.A., Willigenburg, N.W. et al. A systematic comparison of the closed shoulder reduction techniques. Arch Orthop Trauma Surg 137, 589–599 (2017). https://doi.org/10.1007/s00402-017-2648-4

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