Prediction of fracture associated with anterior shoulder dislocation.
Date First Published:
May 12, 2005
Last Updated:
May 17, 2005
Report by:
Steffen Genthe, MD, Emergency Medicine Resident II (Michigan State University GRMERC Emergency Medicine Residency)
Search checked by:
Steffen Genthe, MD, Michigan State University GRMERC Emergency Medicine Residency
Three-Part Question:
In [emergency department patients with anterior shoulder dislocation] which [historical factors predict] [shoulder fracture]?
Clinical Scenario:
Your are an emergency medicine resident in a busy downtown tertiary care facility. Your 14th patient of the night is a 23-year-old male with a clinically obvious anterior shoulder dislocation. The dislocation was spontaneous and is his third this year. As a matter of routine a pre-reduction x-ray is ordered. ED beds are scarce and the the nurse asks if this is really necessary. Is it?
Search Strategy:
Medline 1966-03/05 using the OVID interface, Cochrane Library (2005)
Search Details:
[(exp shoulder dislocation/ or anterior shoulder dislocation.mp) AND (*shoulder fractures/di, ra, ep). LIMIT to human AND English.
Outcome:
37 papers found of which 36 were irrelevant or of insufficient quality.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Clinical factors predicting fractures associated with an anterior shoulder dislocation. Emond M. Le Sage N. Lavoie A. Rochette L. 2004 Aug USA | Patients with anterior shoulder dislocation in a university-affiliated ED. | Emond M. Le Sage N. Lavoie A. Rochette L. Clinical factors predicting fractures associated with an anterior shoulder dislocation. Academic Emergency Medicine. 11(8):853-8, 2004 Aug. | Retrospective Prediction rule was validated only within the sample |
Bottom Line:
In selected patients, x-rays may be unnecessary in the management of anterior shoulder dislocation.
References:
- Emond M. Le Sage N. Lavoie A. Rochette L.. Clinical factors predicting fractures associated with an anterior shoulder dislocation.