Management of first-time dislocations of the shoulder in patients older than 40 years: the prevalence of iatrogenic fracture.
OBJECTIVE
To evaluate the prevalence of iatrogenic humeral neck fracture after attempted closed reduction in patients older than 40 years who present with a first-time anterior dislocation.


METHODS
Retrospective cohort study, evidence-based medicine level IV.


METHODS
Ninety-two patients older than 40 years (mean 66.6 years of age) with a first-time anterior dislocation of the shoulder.


METHODS
Closed reductions by the emergency medicine physicians under conscious sedation, in the emergency department.


METHODS
Prevalence of iatrogenic fracture on postreduction radiographs.


RESULTS
Nineteen (20.7%) patients were diagnosed with a concomitant greater tuberosity fracture on initial radiograph. In the postreduction radiographs, 5 patients (5.4%) were identified with a postreduction humeral neck fracture, and all of them had a greater tuberosity fracture on initial radiographs. A highly significant association (P < 0.0001) was observed between the finding of a greater tuberosity fracture on the initial radiographs and the occurrence of iatrogenic humeral neck fracture after close reduction.


CONCLUSIONS
Previous case reports have described an iatrogenic humeral neck fracture with reduction attempt of shoulder dislocation. In our retrospective study, 21% of the cohort of patients older than 40 years had a concomitant greater tuberosity fracture; 26% of them had an iatrogenic humeral neck fracture after reduction attempt under sedation in the emergency room. These patients ended up with poor outcome.


CONCLUSIONS
Patients older than 40 years, presenting with a first-time anterior shoulder dislocation with an associated fracture of the greater tuberosity have a significant rate of iatrogenic humeral neck fracture during closed reduction under sedation.
Reading Shoulder Unit, Royal Berkshire Hospital, Reading, United Kingdom.
Ehud
E
Atoun
Ali
A
Narvani
Tirtza
T
Even
Hitesh
H
Dabasia
Alexander
A
Van Tongel
Giuseppe
G
Sforza
Ofer
O
Levy
D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012783:Shoulder Dislocation / Q000628:therapy*; D012784:Shoulder Fractures / Q000000981:diagnostic imaging / Q000453:epidemiology*