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- Talk
- UK
Is Closed Reduction of Glenohumeral Dislocations with an Associated Tuberosity Fracture Safe in the Emergency Department?
Description
In this presentation by Sam Mackenzie at the Edinburgh International Trauma Symposium, the speaker discusses the management of glenohumeral joint dislocations accompanied by isolated tuberosity fractures. Mackenzie emphasizes the evolution of their understanding since the 2018 British Orthopedic Association Conference, where concerns about the safety of closed reductions in the emergency department (ED) were highlighted. He notes that while some advocate for surgical reduction under general anesthesia, their center has successfully implemented a policy allowing ED reductions under procedural sedation.
The study aims to evaluate the safety, identify risk factors for manipulation failure, and assess early outcomes of this approach. They analyzed data from 188 patients with isolated tuberosity fractures, revealing that most dislocations were anterior and occurred typically after falls. The study reports a high success rate for ED reductions with a low rate of iatrogenic fractures, reinforcing the utility of their practice.
The findings led to recommendations for clinicians, emphasizing that only acute injuries should be manipulated if the integrity of the humeral neck can be confidently established through radiography and that the clinician must be experienced in sedation and reduction techniques. Recommendations also call for limiting attempts at reduction to two, with further emphasis on the necessity of orthopedic consultation in uncertain cases. Mackenzie concludes with an advocacy for continued education and protocol adherence in emergency settings.