title: The effectiveness of a specially designed shoulder chair for closed reduction of acute shoulder dislocation in the emergency department: a randomised control trial.
abstract: OBJECTIVE
  The objective of this study was to demonstrate the effectiveness of a specially designed chair for closed reduction of acute shoulder dislocations.
  
  
  METHODS
  This was a prospective, non-blinded randomised controlled trial conducted in a university affiliated emergency department (ED). The inclusion criteria were (1) age ≥18 years; (2) anterior or posterior shoulder dislocation without fracture of the surgical neck of the humerus; (3) patient who is able to communicate and cooperate. Participants were randomly assigned using a computer generated random number sequence into one of two groups--either the traditional practice group or Oxford chair group. Administration of intravenous sedation was only permitted in the traditional practice group due to the concerns of sedation use in the sitting position while unsupported on the chair. The primary outcome measure was length of ED stay. The secondary outcome measures were length of time for the procedure, successful reduction rate, levels of pain experienced by patients in different time periods before and after the reduction.
  
  
  RESULTS
  Sixty eligible patients were recruited, 30 in each group. The median lengths of stay in the ED in Oxford chair group (n=30) and traditional method group (n=30) were 152 min and 173 min respectively (p=0.183). The median procedure time was 3 min for the Oxford chair group compared to 5 min in the traditional method group (p=0.179). The success rate for the Oxford chair method was 77% (23/30). There were no statistically or clinically significant differences of pain score at any point.
  
  
  CONCLUSIONS
  The chair method had a 77% success rate in reducing acute shoulder dislocations without sedation. There was no difference in pain level experienced by patients between the chair method and the traditional method. Patient factors, including patients who have had previous shoulder surgery and patients who have fracture dislocations, contribute to the reduced efficacy of the chair method. It remains possible that the chair method may reduce patient length of stay in the ED in uncomplicated patients.
authors.affiliation: Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR. jo.chungym@gmail.com
authors.forename: Josephine Yuen Man
authors.initials: JY
authors.lastname: Chung
authors.forename: Chi Hung
authors.initials: CH
authors.lastname: Cheng
authors.forename: Colin A
authors.initials: CA
authors.lastname: Graham
authors.forename: Timothy H
authors.initials: TH
authors.lastname: Rainer
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D004389:Durable Medical Equipment; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008349:Manipulation, Orthopedic / Q000295:instrumentation* / Q000379:methods; D008875:Middle Aged; D010147:Pain Measurement / Q000706:statistics & numerical data; D056888:Patient Positioning / Q000295:instrumentation* / Q000379:methods; D011446:Prospective Studies; D012783:Shoulder Dislocation / Q000628:therapy*; D055815:Young Adult
keywords: musculo-skeletal, fractures and dislocations