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AKUT TRAVMATİK İLK KEZ ÖNE OMUZ ÇIKIĞININ GÜNCEL TEDAVİ UYGULAMALARINDA ORTOPEDİ VE ACİL TIP UZMANLARININ YAKLAŞIM FARKLILIKLARI

Year 2021, Volume: 28 Issue: 4, 599 - 606, 30.12.2021
https://doi.org/10.17343/sdutfd.917151

Abstract

Amaç
Anterior glenohumeral eklem çıkıklarının yerine oturtulmasına
(redüksiyonuna) yönelik çok sayıda teknik
tarif edilmiştir. Bununla birlikte, glenohumeral eklem
çıkığı redüksiyonu için en iyi teknik konusunda fikir
birliği yoktur. Bu çalışma, akut travmatik ilk kez öne
(anterior) omuz çıkığının tedavisinde acil uzmanları
ve ortopedi cerrahlarının yaklaşımlarını değerlendirmeyi
amaçlamaktadır.
Gereç ve Yöntem
Bu kesitsel çalışmada kullanılan veriler, Türkiye Ortopedi
ve Travmatoloji Derneği posta grubu ve Türkiye
Acil Tıp Hekimleri Derneği posta grubundan web
tabanlı bir anket yoluyla elde edilmiştir. Veritabanına
kayıtlı tüm ortopedi cerrahları ve acil tıp doktorları anketin
amacına ilişkin bir bilgilendirme postası ve çevrimiçi
anket formuna (Google Forms, Alphabet Inc.,
Mountain View, CA) bir bağlantı aldı. Anket, karşılık
gelen cevap seçenekleriyle gösterilen 13 sorudan
oluşuyordu. Türkiye'deki ortopedi cerrahları ve acil
tıp hekimleri arasında akut travmatik ilk kez anterior
omuz çıkığının tedavisine yönelik güncel uygulamalar
değerlendirildi.
Bulgular
Bu ankete toplam 152 ortopedi cerrahı ve 151 acil
uzmanı katılmıştır. Acil uzmanlarının omuz çıkığını
redükte etmek için en sık kullandıkları manevralar
Hipokrat tekniği (% 19,2) ve Cunningham tekniği (%
19,2) iken, ortopedi cerrahları Hipokrat tekniğini (%
23,7) ve Kocher tekniğini (% 29,6) tercih etti. Ortopedi
cerrahlarının omuz eklemi çıkığını azaltmak için acil
uzmanlarına göre daha çok Kocher ve Milch manev-
ralarını tercih ettikleri bulundu (sırasıyla p <0,001 ve p
= 0,005). Hem redüksiyon öncesi hem de redüksiyon
sonrası prosedürler ortopedi cerrahları ve acil tıp doktorları
arasında değişkenlik gösterdi.
Sonuç
Acil uzmanı ve ortopedi cerrahlarının omuz çıkığı olan
bir hastayı bir ekip olarak tedavi etmeleri ve uzlaşı için
ulusal bir kılavuz oluşturmaları daha uygun olacaktır.

References

  • 1. Krøner K, Lind T, Jensen J. The epidemiology of shoulder dislocations. Arch Orthop Trauma Surg 1989;108:288–90. https://doi.org/10.1007/BF00932317.
  • 2. Berendes TD, Pilot P, Nagels J, Vochteloo AJ, Nelissen RG. Survey on the management of acute first-time anterior shoulder dislocation amongst Dutch public hospitals. Arch Orthop Trauma Surg 2015;135:447–54. https://doi.org/10.1007/s00402-015-2156-3.
  • 3. Alkaduhimi H, van der Linde JA, Flipsen M, van Deurzen DF, van den Bekerom MP. A systematic and technical guide on how to reduce a shoulder dislocation. Turk J Emerg Med 2016;16:155-168. https://doi.org/10.1016/j.tjem.2016.09.008.
  • 4. Dannenbaum J, Krueger CA, Johnson A. A review of reduction techniques for anterior glenohumeral joint dislocations. J Spec Oper Med 2012;12:83–92.
  • 5. Guner S, Guner SI, Gormeli G, Turkozu T, Gormeli CA, Bora A. A simple, safe and painless method for acute anterior glenohumeral joint dislocations: “the forward elevation maneuver”. Arch Orthop Trauma Surg 2013;133:1095–9. https://doi.org/10.1007/s00402-013-1769-7.
  • 6. Kuhn JE. Treating the initial anterior shoulder dislocation--an evidence-based medicine approach. Sports Med Arthrosc 2006;14:192–8. https://doi.org/10.1097/01.jsa.0000212328.25345.de.
  • 7. Cutts S, Prempeh M, Drew S. Anterior shoulder dislocation. Ann R Coll Surg Engl 2009;91:2-7. https://doi.org/10.1308/003588409X359123.
  • 8. Riebel GD, McCabe JB. Anterior shoulder dislocation: a review of reduction techniques. Am J Emerg Med 1991;9:180–8. https://doi.org/10.1016/0735-6757(91)90187-o.
  • 9. Liavaag S, Brox JI, Pripp AH, Enger M, Soldal LA, Svenningsen SJ. Immobilization in external rotation after primary shoulder dislocation did not reduce the risk of recurrence: a randomized controlled trial. J Bone Joint Surg Am 2011;93:897–904. https://doi.org/10.2106/JBJS.J.00416.
  • 10. Chong M, Karataglis D, Learmonth D. Survey of the management of acute traumatic first-time anterior shoulder dislocation among trauma clinicians in the UK. Ann R Coll Surg Engl 2006;88:454–8. https://doi.org/10.1308/003588406X117115.
  • 11. Tingart M, Bäthis H, Bouillon B, Tiling T. Therapy of traumatic anterior shoulder dislocation: current status of therapy in Germany. Are there scientifically verified therapy concepts? Chirurg 2001;72:677–83. https://doi.org/10.1007/s001040170123.
  • 12. Hendey GW, Chally MK, Stewart VB. Selective radiography in 100 patients with suspected shoulder dislocation. J Emerg Med 2006;31:23–8. https://doi.org/10.1016/j.jemermed.2005.09.006.
  • 13. Paterson WH, Throckmorton TW, Koester M, Azar FM, Kuhn JE. Position and duration of immobilization after primary anterior shoulder dislocation: a systematic review and meta-analysis of the literature. J Bone Joint Surg Am 2010;92:2924–33. https://doi.org/10.2106/JBJS.J.00631.
  • 14. Kiviluoto O, Pasila M, Jaroma H, Sundholm A. Immobilization after primary dislocation of the shoulder. Acta Orthop Scand 1980;51:915–9. https://doi.org/10.3109/17453678008990894.
  • 15. Itoi E, Hatakeyama Y, Kido T, Sato T, Minagawa H, Wakabayashi I, et al. A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study. J Shoulder Elbow Surg 2003;12:413–5. https://doi.org/10.1016/s1058-2746(03)00171-x.
  • 16. Yamamoto N, Sano H, Itoi E. Conservative treatment of first-time shoulder dislocation with the arm in external rotation. J Shoulder Elbow Surg 2010;19(suppl):98–103. https://doi.org/10.1016/j.jse.2009.12.018.
  • 17. Itoi E, Hatakeyama Y, Itoigawa Y, Omi R, Shinozaki N, Yamamoto N, et al. Is protecting the healing ligament beneficial after immobilization in external rotation for an initial shoulder dislocation? Am J Sports Med 2013;41:1126–32. https://doi.org/10.1177/0363546513480620.
  • 18. Kosnik J, Shamsa F, Raphael E, Huang R, Malachias Z, Georgiadis GM. Anesthetic methods for reduction of acute shoulder dislocations: a prospective randomized study comparing intraarticular lidocaine with intravenous analgesia and sedation. Am J Emerg Med 1999;17:566–70. https://doi.org/10.1016/s0735-6757(99)90197-3.
  • 19. Uglow MG. Kocher’s painless reduction of anterior dislocation of the shoulder: a prospective randomised trial. Injury 1998;29:135–7.
  • 20. Yuen MC, Tung WK. Reducing Anterior Shoulder Dislocation by the Spaso Technique. HK J Emerg Med 2001;8:96–100. https://doi.org/10.1016/s0020-1383(97)00168-x.
  • 21. Daya M. Shoulder. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. MO: Mosby Inc; 2002:576-606.

APPROACH DIFFERENCES OF ORTHOPEDICS AND EMERGENCY MEDICINE PHYSICIANS IN CURRENT TREATMENT PRACTICES OF ACUTE TRAUMATIC FIRST TIME ANTERIOR SHOULDER DISLOCATION

Year 2021, Volume: 28 Issue: 4, 599 - 606, 30.12.2021
https://doi.org/10.17343/sdutfd.917151

Abstract

Objective
Numerous techniques for the reduction of anterior
glenohumeral joint dislocations have been described.
However, there is no consensus on the best technique
for reducing a dislocated glenohumeral joint. This
study aimed to evaluate the approach of emergency
specialists and orthopedic surgeons in the treatment
of acute traumatic first-time anterior shoulder
dislocation.
Material and Methods
Data used in this cross-sectional study were obtained
through a web-based survey from the Turkish
Orthopedics and Traumatology Association mail group
and Emergency Medicine Physicians Association
of Turkey mail group. All orthopedic surgeons
and emergency medicine physicians who were
registered in the database received an information
mail regarding the aim of the questionnaire and a link
to the online survey form (Google Forms, Alphabet
Inc., Mountain View, CA). The survey consisted of 13
questions, which are shown with their corresponding
answer options. The current practices regarding the
management of acute traumatic first-time anterior
shoulder dislocation among orthopedic surgeons
and emergency medicine physicians in Turkey were
evaluated.
Results
A total of 152 orthopedic surgeons and 151 emergency
physicians participated in this survey. The most
common maneuvers used by emergency physicians
to reduce shoulder dislocations were the Hippocrates
technique (19.2%) and Cunningham technique
(19.2%), while orthopedic surgeons preferred the
Hippocrates technique (23.7%) and Kocher technique
(29.6%). It was found that orthopedic surgeons
preferred Kocher and Milch maneuvers more for
shoulder joint dislocation reduction compared to
emergency physicians (p < 0.001 and p = 0.005,
respectively). Both the pre- reduction and postreduction
procedures showed variability between
orthopedic surgeons and emergency physicians.
Conclusion
It would be more appropriate for the emergency
physician and orthopedic surgeons to treat a
patient with shoulder dislocation together as a team
and beneficial to establish a national guideline for
consensus.

References

  • 1. Krøner K, Lind T, Jensen J. The epidemiology of shoulder dislocations. Arch Orthop Trauma Surg 1989;108:288–90. https://doi.org/10.1007/BF00932317.
  • 2. Berendes TD, Pilot P, Nagels J, Vochteloo AJ, Nelissen RG. Survey on the management of acute first-time anterior shoulder dislocation amongst Dutch public hospitals. Arch Orthop Trauma Surg 2015;135:447–54. https://doi.org/10.1007/s00402-015-2156-3.
  • 3. Alkaduhimi H, van der Linde JA, Flipsen M, van Deurzen DF, van den Bekerom MP. A systematic and technical guide on how to reduce a shoulder dislocation. Turk J Emerg Med 2016;16:155-168. https://doi.org/10.1016/j.tjem.2016.09.008.
  • 4. Dannenbaum J, Krueger CA, Johnson A. A review of reduction techniques for anterior glenohumeral joint dislocations. J Spec Oper Med 2012;12:83–92.
  • 5. Guner S, Guner SI, Gormeli G, Turkozu T, Gormeli CA, Bora A. A simple, safe and painless method for acute anterior glenohumeral joint dislocations: “the forward elevation maneuver”. Arch Orthop Trauma Surg 2013;133:1095–9. https://doi.org/10.1007/s00402-013-1769-7.
  • 6. Kuhn JE. Treating the initial anterior shoulder dislocation--an evidence-based medicine approach. Sports Med Arthrosc 2006;14:192–8. https://doi.org/10.1097/01.jsa.0000212328.25345.de.
  • 7. Cutts S, Prempeh M, Drew S. Anterior shoulder dislocation. Ann R Coll Surg Engl 2009;91:2-7. https://doi.org/10.1308/003588409X359123.
  • 8. Riebel GD, McCabe JB. Anterior shoulder dislocation: a review of reduction techniques. Am J Emerg Med 1991;9:180–8. https://doi.org/10.1016/0735-6757(91)90187-o.
  • 9. Liavaag S, Brox JI, Pripp AH, Enger M, Soldal LA, Svenningsen SJ. Immobilization in external rotation after primary shoulder dislocation did not reduce the risk of recurrence: a randomized controlled trial. J Bone Joint Surg Am 2011;93:897–904. https://doi.org/10.2106/JBJS.J.00416.
  • 10. Chong M, Karataglis D, Learmonth D. Survey of the management of acute traumatic first-time anterior shoulder dislocation among trauma clinicians in the UK. Ann R Coll Surg Engl 2006;88:454–8. https://doi.org/10.1308/003588406X117115.
  • 11. Tingart M, Bäthis H, Bouillon B, Tiling T. Therapy of traumatic anterior shoulder dislocation: current status of therapy in Germany. Are there scientifically verified therapy concepts? Chirurg 2001;72:677–83. https://doi.org/10.1007/s001040170123.
  • 12. Hendey GW, Chally MK, Stewart VB. Selective radiography in 100 patients with suspected shoulder dislocation. J Emerg Med 2006;31:23–8. https://doi.org/10.1016/j.jemermed.2005.09.006.
  • 13. Paterson WH, Throckmorton TW, Koester M, Azar FM, Kuhn JE. Position and duration of immobilization after primary anterior shoulder dislocation: a systematic review and meta-analysis of the literature. J Bone Joint Surg Am 2010;92:2924–33. https://doi.org/10.2106/JBJS.J.00631.
  • 14. Kiviluoto O, Pasila M, Jaroma H, Sundholm A. Immobilization after primary dislocation of the shoulder. Acta Orthop Scand 1980;51:915–9. https://doi.org/10.3109/17453678008990894.
  • 15. Itoi E, Hatakeyama Y, Kido T, Sato T, Minagawa H, Wakabayashi I, et al. A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study. J Shoulder Elbow Surg 2003;12:413–5. https://doi.org/10.1016/s1058-2746(03)00171-x.
  • 16. Yamamoto N, Sano H, Itoi E. Conservative treatment of first-time shoulder dislocation with the arm in external rotation. J Shoulder Elbow Surg 2010;19(suppl):98–103. https://doi.org/10.1016/j.jse.2009.12.018.
  • 17. Itoi E, Hatakeyama Y, Itoigawa Y, Omi R, Shinozaki N, Yamamoto N, et al. Is protecting the healing ligament beneficial after immobilization in external rotation for an initial shoulder dislocation? Am J Sports Med 2013;41:1126–32. https://doi.org/10.1177/0363546513480620.
  • 18. Kosnik J, Shamsa F, Raphael E, Huang R, Malachias Z, Georgiadis GM. Anesthetic methods for reduction of acute shoulder dislocations: a prospective randomized study comparing intraarticular lidocaine with intravenous analgesia and sedation. Am J Emerg Med 1999;17:566–70. https://doi.org/10.1016/s0735-6757(99)90197-3.
  • 19. Uglow MG. Kocher’s painless reduction of anterior dislocation of the shoulder: a prospective randomised trial. Injury 1998;29:135–7.
  • 20. Yuen MC, Tung WK. Reducing Anterior Shoulder Dislocation by the Spaso Technique. HK J Emerg Med 2001;8:96–100. https://doi.org/10.1016/s0020-1383(97)00168-x.
  • 21. Daya M. Shoulder. In: Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th ed. MO: Mosby Inc; 2002:576-606.
There are 21 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research Articles
Authors

Ramadan Özmanevra 0000-0003-0515-4001

Nihat Demirhan Demirkıran 0000-0002-0724-9672

Sercan Çapkın 0000-0001-6957-5927

Ugur Ozkula 0000-0002-1448-0784

Yağmur Işın This is me 0000-0002-6047-8597

Ali İhsan Kılıç 0000-0001-7491-6044

Publication Date December 30, 2021
Submission Date April 16, 2021
Acceptance Date August 17, 2021
Published in Issue Year 2021 Volume: 28 Issue: 4

Cite

Vancouver Özmanevra R, Demirkıran ND, Çapkın S, Ozkula U, Işın Y, Kılıç Aİ. APPROACH DIFFERENCES OF ORTHOPEDICS AND EMERGENCY MEDICINE PHYSICIANS IN CURRENT TREATMENT PRACTICES OF ACUTE TRAUMATIC FIRST TIME ANTERIOR SHOULDER DISLOCATION. Med J SDU. 2021;28(4):599-606.

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