Background: Several methods of reducing an acute anterior
dislocation of the shoulder have been described. The aim of this study was to
assess the effectiveness of the external rotation method in the reduction of
acute anterior shoulder dislocations with and without fractures of the greater
tuberosity and to evaluate the causes of failure.
Methods: Senior and junior orthopaedic residents attending in the
Emergency Department were instructed in the external rotation method for the
reduction of a shoulder dislocation in a classroom setting. Forty patients
with an acute anterior dislocation of the shoulder, with or without an
associated fracture of the greater tuberosity, who were treated with this
method were evaluated prospectively. Data sheets completed by the orthopaedic
residents when this method was used were evaluated with regard to the type of
dislocation, the effectiveness of the procedure in achieving reduction, the
need for premedication, the ease of performing the reduction, and
complications, if any.
Results: Of the forty patients, thirty-six had a successful
reduction. No premedication was required in twenty-nine patients who had a
successful reduction, and the average time required for reduction in twenty
patients was less than two minutes. Only four patients reported severe pain
during the process of reduction. The method was not successful in four
patients, two of whom had a displaced fracture of the greater tuberosity.
Conclusions: The external rotation method for the reduction of an
acute anterior dislocation of the shoulder is a safe and reliable method that
can be performed relatively painlessly for both subcoracoid and subglenoid
dislocations provided that a displaced fracture of the greater tuberosity is
Level of Evidence: Therapeutic study, Level IV (case
series [no, or historical, control group]). See Instructions to Authors for a
complete description of levels of evidence.