Management of prehospital shoulder dislocation: feasibility and need of reduction

Abstract

Purpose: Dislocation of the shoulder is rare in the prehospital setting. The medical specialities of the emergency physicians are heterogeneous, and the level of experience is different. Aim of this study was to evaluate the feasibility, sufficiency, and need of prehospital reduction. Methods: Over 12 months, 16 rescue stations in Germany and Austria documented cases. Points of examination were: incidence of reduction, influence of pathological findings, therapy and effectiveness of reduction. Results: We included 70 patients. A reduction was undertaken in n = 47 (66.6 %). In n = 70 (100 %) perfusion was without pathological finding after reduction, all n = 7 (10 %) neurological pathologies declined after reduction. There was no significance in total implementation of prehospital reduction between surgeons and anaesthetists. N = 63 (90 %) of all patients received an immobilisation of the shoulder. N = 68 (97 %) of all patients were transported to a hospital. Time to arrival in hospital was in n = 50 (71.4 %) ≤10 min, in n = 17 (24.2 %) ≤20 min and in n = 3 (4.4 %) ≤30 min. Conclusion: Implementation of reduction is independent of pathological neurological or vascular findings. Knowledge and skill is enough to perform a reduction quiet effectively in all emergency physicians. No specific technique can be recommended for prehospital use, the importance of being skilled is more important than one method. Early reduction was performed most rapidly in surgeons, but as well in the recommended time by other medical disciplines. On documented timings to admission hospital waiver of reduction is doubt. Therefore, a reduction in the prehospital setting is possible, but not obligatory.