Abstract
A comprehensive postal questionnaire was sent to 164 orthopaedic consultants, all members of the Brit-ish Elbow and Shoulder Society. Questions were asked about the initial reduction, investigations undertaken, timing of any surgery, preferred stabilization procedure, arthroscopic or open, detail of surgical technique, period of immobilization and rehabilitation programmes instigated in first-time and recurrent traumatic dislocators. The response rate was 83% (n=136)
The most likely treatment of a young traumatic shoulder dislocation:
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It will be reduced under sedation in A& E by the A& E doctor.
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Apart from x-ray, no investigations will be performed
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It will be immobilised for 3 weeks, then given course of physiotherapy
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Upon their second dislocation, they will be listed directly for an open Bankart procedure (with capsular shift as indicated) during which subscapularis will be detached and metallic bone anchors used
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Following surgery, they will be immobilised for 3 to 4 weeks, before being permitted full range of movement at 2 to 3 months and allowed to return to contact sports at 6 to 12 months
On the other hand, 54% of surgeons indicated they would investigate prior to surgery, 16% said their first choice operation would be arthroscopic stabilisation, the number of dislocations normally permitted before surgery ranged from 1 to more than 3, and the period of immobilisation post operation from nil to 6 weeks.
The results reveal a wide variation in practice and no clear consensus on how to best manage these patients. Open stabilisation remains the firm favourite. Does this mean arthroscopic stabilisation is regarded as an experimental procedure?
The abstracts were prepared by Mr Tim Briggs. (Editoral Secretary 2003/4) Correspondence should be addressed to him at Lane Farm, Chapel Lane, Totternhoe, Dunstable, Bedfordshire LU6 2BZ, United Kingdom
