title: The external rotation method for reduction of acute anterior shoulder dislocations.
abstract: BACKGROUND
  Shoulder dislocations account for almost 50% of all joint dislocations, and are most commonly anterior (90-98%) and occur due to trauma. This prospective study was conducted to report our experiences of using the external rotation method (ERM) in the reduction of acute anterior shoulder dislocation.
  
  
  METHODS
  Between August 2006 and April 2007, ERM was applied to 31 patients who presented with traumatic anterior shoulder dislocation to the Emergency Department of our Hospital which is a level 2 trauma centre. We evaluated 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 31 patients, 29 had a successful reduction. No premedication was required in 25 patients who had a successful reduction, and the average time required for reduction in 25 was less than 2 min. Only five patients reported severe pain during the process of reduction. The method was not successful in two patients in whom the reduction was achieved under narcosis. We experienced a success rate of 89% at the first attempt. None of the patients encountered any complication.
  
  
  CONCLUSIONS
  ERM for the reduction of acute anterior dislocation of the shoulder is a safe and reliable method, mainly without requirement for any sedatives or opiate analgesics, that can be performed relatively painlessly for anterior shoulder dislocations. As no single method has a 100% success rate, ERM is a useful one to know.
authors.affiliation: Cattedra di Ortopedia e Traumatologia, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Ancona, Via Conca, Torrette, 60100, Ancona, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Marinelli
authors.forename: Luigi
authors.initials: L
authors.lastname: de Palma