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

Öz

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.

Anahtar Kelimeler

• 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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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