MANAGEMENT OF TRAUMATIC ANTERIOR SHOULDER DISLOCATION, THE UK PERSPECTIVE

Aim: To survey how acute, traumatic, first-time anterior shoulder dislocation (AFSD) is managed amongst trauma clinicians in the current clinical setting in UK hospitals. Design: Postal Questionnaire. Method: 228 questionnaires were sent out to list of active consultant member of the British Trauma Society practising in various hospitals around United Kingdom. Questions were laid out in two workgroups. In work-group one, an assortment of questions were asked with the emphasis on management in AFSD from the point of entry in a casualty department to departure and after-care. In workgroup two, case scenarios were included to look in the ‘aftercare’ management in three distinct age groups; young ( 65 years old). Results: The response rate of the questionnaires was 51%. Twenty-two per cent of respondents have local protocol for managing AFSD. All respondents recommended pre-and post-reduction X-rays as standard practice. Most respondents favoured systemic analgesia with ‘airways monitoring’, as opposed to intra-articular anaesthesia (68 versus 9). Kocher and Hippocrates were the most popular methods of reduction. Eighty-four respondents advocated immobilisation in internal rotation compared to six in external rotation. Only a small number of respondents would perform an immediate arthroscopic stabilisation in young, fit patients presenting with this type of injury (16 of 84). Conclusion: This survey revealed the current practice of trauma clinicians in managing AFSD on the ‘front-line’. We conclude that there is significant variation in response to the issues incorporated in this survey. There is a need to address the issues of intra-articular analgesia, immobilisation technique and management of AFSD amongst young patient with regards to immediate surgical intervention. We suggest that these issues be revised and clarified, ideally in a randomised controlled clinical trial prior to the introduction of a protocol for managing this problem.