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

Ramadan Özmanevra Nihat Demirhan Demirkıran Sercan Çapkın Ugur Ozkula Yağmur Işın Ali İhsan Kılıç

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.

Keywords

glenohumeral çıkık, ortopedi cerrahı, acil bölümü, manevra, anket

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

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.

Keywords

glenohumeral dislocation, orthopedic surgeon, emergency department, maneuver, survey

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