Description
In this presentation led by Dr. John Keating at a symposium's final session, the focus is on shoulder joint injuries, particularly related to fracture dislocations. After acknowledging a related talk given by Mike Gardner, which was the Lister Lecture on shoulder fractures, Dr. Keating introduces the session's agenda, emphasizing case discussions in addition to presentations he and his colleagues will lead.
Dr. Keating dives into the common injuries associated with the shoulder, primarily highlighting proximal humeral fractures and glenohumeral dislocations, specifically anterior dislocations. He discusses the rarity of fracture dislocations compared to other injuries, referencing recent epidemiological research that he conducted on patients in Edinburgh. Key data reveals that of 409 proximal humeral fractures, only 2% were associated with dislocation, underlining the uncommon nature of such injuries and the corresponding need for surgical intervention as opposed to emergency department reductions.
Emphasizing the high incidence of greater tuberosity fractures accompanying anterior dislocations, he explains that despite being fairly common, these injuries require meticulous assessment and often cannot be treated effectively in an emergency setting. Presenting statistics from a four-year analysis, he outlines the outcomes of closed reductions specifically for these injuries. The findings suggest an 80% success rate in the emergency department, with minimal documented complications, and categorizing all instances of failed reductions, rendering the practice largely safe under proper protocols.
Dr. Keating concludes with recommendations for practice, stipulating that while closed reductions are generally safe, adherence to strict guidelines regarding attempts and thorough neurological evaluations is crucial, especially given the associated injury risks observed.