title: A systematic comparison of the closed shoulder reduction techniques.
abstract: OBJECTIVE
  To identify the optimal technique for closed reduction for shoulder instability, based on success rates, reduction time, complication risks, and pain level.
  
  
  METHODS
  A PubMed and EMBASE query was performed, screening all relevant literature of closed reduction techniques mentioning the success rate written in English, Dutch, German, and Arabic. Studies with a fracture dislocation or lacking information on success rates for closed reduction techniques were excluded. We used the modified Coleman Methodology Score (CMS) to assess the quality of included studies and excluded studies with a poor methodological quality (CMS < 50). Finally, a meta-analysis was performed on the data from all studies combined.
  
  
  RESULTS
  2099 studies were screened for their title and abstract, of which 217 studies were screened full-text and finally 13 studies were included. These studies included 9 randomized controlled trials, 2 retrospective comparative studies, and 2 prospective non-randomized comparative studies. A combined analysis revealed that the scapular manipulation is the most successful (97%), fastest (1.75 min), and least painful reduction technique (VAS 1,47); the "Fast, Reliable, and Safe" (FARES) method also scores high in terms of successful reduction (92%), reduction time (2.24 min), and intra-reduction pain (VAS 1.59); the traction-countertraction technique is highly successful (95%), but slower (6.05 min) and more painful (VAS 4.75).
  
  
  CONCLUSIONS
  For closed reduction of anterior shoulder dislocations, the combined data from the selected studies indicate that scapular manipulation is the most successful and fastest technique, with the shortest mean hospital stay and least pain during reduction. The FARES method seems the best alternative.
authors.affiliation: Shoulder and Elbow Unit, Joint Research, OLVG, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Alkaduhimi
authors.affiliation: Shoulder and Elbow Unit, Joint Research, OLVG, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands.
authors.forename: J A
authors.initials: JA
authors.lastname: van der Linde
authors.affiliation: Shoulder and Elbow Unit, Joint Research, OLVG, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands.
authors.forename: N W
authors.initials: NW
authors.lastname: Willigenburg
authors.affiliation: Shoulder and Elbow Unit, Joint Research, OLVG, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands.
authors.forename: D F P
authors.initials: DFP
authors.lastname: van Deurzen
authors.affiliation: Shoulder and Elbow Unit, Joint Research, OLVG, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands.
authors.forename: M P J
authors.initials: MPJ
authors.lastname: van den Bekerom
mesh_terms: D057186:Comparative Effectiveness Research; D006801:Humans; D007593:Joint Instability / Q000628:therapy*; D008349:Manipulation, Orthopedic / Q000379:methods*; D012783:Shoulder Dislocation / Q000628:therapy*
keywords: Glenohumeral; Instability; Maneuver; Reposition; Shoulder; Techniques