Objective To explore the injury assessment and the control measure for the related complication before the manual reduction of anterior shoulder dislocations.Methods General data:56 patients suffered anterior shoulder dislocations were retrospectively analyzed in our study.31 were male and 25 were female,and their ages ranged from 23 to 85 years old with the mean age of 36.5 years old.10 patients got injured at car accidents.32 injuries resulted from falling,8 of which fell from the height,and 6 were injured in sports.The time before going to hospital ranged from 15 minutes to 8 hours with a mean time of 1.6 hours.All of the shoulder dislocations were fresh and traumatic.For the dislocation direction,31 were subcoracoid dislocations,20 were subglenoid dislocations,and 5 were subclavicle dislocations,15 patients were associated with fractures of greater tuberosity,1 humeral head fracture,and 3 axillary nerve injuries,2 Iatrogenic proximal humeral fractures.Inclusion criteria:Patients had a clear history of shoulder trauma.The squared shoulder deformation was showed by physical examination,and the humeral head could be touched in the axillary,subcoracoid,or subclavicle.The shoulder dislocation was also confirmed by the radiographic diagnosis.Treatment:100 mg lidocaine was injected into the shoulder joint,and then the dislocations were reduced using the Hippocrates method after about 10 minutes when the pain was relieved.Results All the patients received closed reduction by the Hippocrates method in the emergency room.48 patients had successful reduction,8 patients failed.Of these 8 cases,closed reduction succeeded in one case with the fracture of greater tuberosity at the operation room with general anesthesia,manual reduction was done in 2 cases with brachial plexus block,and open reduction was done in one case with humeral head fracture.Conclusions A series of careful assessment should be done before gimmick reset of the anterior shoulder dislocation,including the analysis of the image data.If the gimmick reset failed,to avoid the violent iatrogenic damage,further image examination need be done,and the reduction need to be done with general anesthesia of brachial plexus anesthesia when necessary.The accurate judgment of complications was needed to reduce the occurrence of iatrogenic injury.
