This poster was originally presented at the RANZCR Annual Scientific Meeting 2011, October 6-9, in Melbourne/AU.
Congress:
RANZCR ASM 2011
Keywords:
Musculoskeletal bone, Musculoskeletal joint, Emergency, Digital radiography, Conventional radiography, Decision analysis, Athletic injuries, Trauma
Authors:
N. Kutaiba1, J. Cruickshank1, D. Arhanghelschi1, A. Al Joboory2; 1Ballarat/AU, 2Melbourne/AU
DOI:
10.1594/ranzcr2011/R-0104
Purpose
Patients with shoulder dislocations commonly present to emergency departments with anterior dislocations accounting for 90-95% of these cases1.
Diagnosis is based on history and clinical examination with radiography confirmation.
Following reduction,
radiography is traditionally obtained to confirm gleno-humeral enlocation and to look for associated fractures.
Pre- and post-reduction x-rays are obtained to confirm dislocation and reduction respectively and to rule out fractures.
The most common fractures associated with anterior shoulder dislocations are Hill-Sachs and Bankart lesions which rarely alter acute management2.
Emergency physicians are often certain of diagnosing anterior shoulder dislocations based on history and clinical examination.
Some emergency physicians proceed to reducing dislocated shoulders without a pre-reduction x-ray based on clinical experience and judgment3,4.
Recent studies have shown that clinical predictors can be used to anticipate which patients are likely to have fracture-dislocations,
for which pre-reduction x-rays would be necessary5,6.
Routine pre-reduction x-rays for patients who are unlikely to have these fracture-dislocations have therefore been questioned.
In addition,
the role of post-reduction x-rays has been challenged since 19927.
Reasons to obtain post-reduction x-rays would be to confirm diagnosis and to visualize fractures not seen on pre-reductions x-rays.
However,
these x-rays do not alter ED management or clinical outcome in most of the cases,
especially in recurrent atraumatic dislocations.
The goal of this article is to review the literature for current guidelines and recommendations for imaging in suspected anterior shoulder dislocations in ED and retrospectively evaluate current practice in a regional hospital in Victoria,
Australia.