title: Closed reduction techniques in acute anterior shoulder dislocation: modified Milch technique compared with traction-countertraction technique.
abstract: BACKGROUND
  To perform closed manual reduction of acute anterior shoulder dislocation using the traction-countertraction technique requires sedation (TCTS) and the participation of 2 people. We studied the modified Milch (MM) technique, a positional reductive maneuver that requires 1 operator, without patient sedation or analgesia.
  
  
  METHODS
  The study comprised 56 prospective nonrandomized consecutive patients, of whom 31 were in group A (MM, nonsedated) and 25 in group B (TCTS).
  
  
  RESULTS
  The success rate of MM technique was 83.9% (26 of 31), which increased to 96.3% (26 of 27) when 4 patients with associated greater tuberosity fractures were excluded. The success rate was 100% in the TCTS group, with 5 patients with associated greater tuberosity fractures. The reduction in pain from the preprocedural to intraprocedural phases in MM group was significant (P < .001), at a reduction rate of 2.07 (29%) on the numeric rating scale pain score. There was a greater pain reduction rate of 2.43 (34%) on the numeric rating scale when patients with greater tuberosity fractures were excluded. The MM group had a significantly shorter hospital stay (mean, 35 minutes) than the TCTS group (mean, 4 hours). No postreduction neurovascular or fracture complications occurred in either group.
  
  
  CONCLUSIONS
  The results showed that the Milch technique was effective, safe, shortened hospital stay, and was well tolerated. We recommend the modified Milch technique as a first-line maneuver for acute anterior shoulder dislocations without associated fractures.
authors: Orthopaedic Department, University of Malaya, Kuala Lumpur, Malaysia.
authors: Simmrat
authors: S
authors: Singh
authors: Chee Khuen
authors: CK
authors: Yong
authors: Sureisen
authors: S
authors: Mariapan
mesh_terms: D000328:Adult; D016292:Procedural Sedation; D005260:Female; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012399:Rotation; D012783:Shoulder Dislocation / Q000628:therapy*; D014143:Traction; D016896:Treatment Outcome