The role of post-reduction radiographs after shoulder dislocation.
We sought to determine whether post-reduction radiographs add clinically important information to what is seen on pre-reduction X-rays in Emergency Department (ED) patients with anterior shoulder dislocations. In this prospective, observational study, clinicians recorded preliminary pre-reduction and post-reduction X-ray readings on patients with shoulder dislocations. The films were subsequently reviewed by a blinded attending radiologist. Seventy-three patients presented to the ED with shoulder dislocations over an 18-month period; 55 of these patients had pre- and post-reduction X-rays and were included in the study. Eight of these patients had fractures seen on preliminary reading of post-reduction X-rays; one (1.8%, 95% confidence interval [CI] 0-9.7%) of these fractures was not seen on preliminary reading of pre-reduction films. On preliminary reading, all patients' shoulders were relocated on post-reduction X-rays (100%; 95% CI 93.5-100%). Forty of these patients had their X-rays read by a blinded attending radiologist. Sixteen fractures were seen on post-reduction X-rays, of which 6 (15.0%; 95% CI 5.7-29.8%) were not seen on pre-reduction X-rays. All patients (100%; 95% CI 91.2-100%) whose post-reduction films were read by blinded attending radiologists had shoulder relocation confirmed. In conclusion, although the majority (62.5%) of fractures associated with shoulder dislocations are seen on pre-reduction radiographs, more than one-third (37.5%) of fractures may be visible only on post-reduction X-rays. None of the fractures missed on pre-reduction X-rays changed patient management in the ED. There were no persistent shoulder dislocations found on post-reduction films.
Kahn
Joseph H
JH
Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
Mehta
Supriya D
SD
D000293:Adolescent; D000328:Adult; D000368:Aged; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005188:False Negative Reactions; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D012783:Shoulder Dislocation / Q000150:complications* / Q000000981:diagnostic imaging* / Q000628:therapy; D012784:Shoulder Fractures / Q000150:complications / Q000000981:diagnostic imaging*; D012785:Shoulder Joint / Q000000981:diagnostic imaging