title: The external rotation method for reduction of acute anterior dislocations and fracture-dislocations of the shoulder.
abstract: 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 not present.
authors.affiliation: Department of Orthopaedics, All India Institute of Medical Sciences, Room 5019, Ansari Nagar, New Delhi 110 029, India. kke75@yahoo.co.uk
authors.forename: Krishna Kiran
authors.initials: KK
authors.lastname: Eachempati
authors.forename: Aman
authors.initials: A
authors.lastname: Dua
authors.forename: Rajesh
authors.initials: R
authors.lastname: Malhotra
authors.forename: Surya
authors.initials: S
authors.lastname: Bhan
authors.forename: John Ranjan
authors.initials: JR
authors.lastname: Bera
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D012783:Shoulder Dislocation / Q000628:therapy*; D012784:Shoulder Fractures / Q000150:complications* / Q000601:surgery