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The External Rotation Method for Reduction of Acute Anterior Dislocations and Fracture-Dislocations of the Shoulder

¹ Departments of Orthopaedics (K.K.E., A.D., R.M., and S.B.) and Emergency Medicine (J.R.B.), All India Institute of Medical Sciences, Room 5019, Ansari Nagar, New Delhi 110 029, India. E-mail address for K.K. Eachempati: kke75{at}yahoo.co.uk. E-mail address for A. Dua: amandua{at}rediffmail.com. E-mail address for R. Malhotra: rmalhotra62{at}hotmail.com. E-mail address for S. Bhan: suryabhan{at}hotmail.com.

Investigation performed at the All India Institute of Medical Sciences, New Delhi, India

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Methods: Senior and junior orthopaedic residents attending in the Emergency Department were instructed in the external rotation method for the reduction of a shoulder dislocation in a classroom setting. Forty patients with an acute anterior dislocation of the shoulder, with or without an associated fracture of the greater tuberosity, who were treated with this method were evaluated prospectively. Data sheets completed by the orthopaedic residents when this method was used were evaluated with regard to the type of dislocation, the effectiveness of the procedure in achieving reduction, the need for premedication, the ease of performing the reduction, and complications, if any.

Results: Of the forty patients, thirty-six had a successful reduction. No premedication was required in twenty-nine patients who had a successful reduction, and the average time required for reduction in twenty patients was less than two minutes. Only four patients reported severe pain during the process of reduction. The method was not successful in four patients, two of whom had a displaced fracture of the greater tuberosity.

Conclusions: The external rotation method for the reduction of an acute anterior dislocation of the shoulder is a safe and reliable method that can be performed relatively painlessly for both subcoracoid and subglenoid dislocations provided that a displaced fracture of the greater tuberosity is not present.

Level of Evidence: Therapeutic study, Level IV (case series [no, or historical, control group]). See Instructions to Authors for a complete description of levels of evidence.

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