THE NEW FA.RE.S. (FAST-RELIABLE-SAFE) METHOD OF REDUCTION OF THE ACUTE ANTERIOR DISLOCATION OF THE SHOULDER – A PROSPECTIVE RANDOMIZED COMPARATIVE STUDY

Abstract

Background: There are several methods to reduce anterior shoulder dislocations but only few studies compare the efficacy, safety and reliability of the different techniques. As a result, deciding which technique to use is seldom based on objective criteria. Aim of this prospective, randomized study is to introduce a new method of reduction of the anterior dislocation of the shoulder (“Fares”) and to compare it with the “Hippocrates” and “Kocher” methods, as far as its efficacy, safety and intensity of the pain felt by the patient during the reduction, are concerned.

Methods: Between September 2006 and June 2008, a total of 154 patients suffering from acute anterior shoulder dislocation (accompanied by a fracture of the greater tuberosity or not) were enrolled in the study. Patients were randomly assigned to one of the three study groups (“Fares”, “Hippocrates” and “Kocher”) and underwent reduction of their dislocation performed by first and second-year residents orthopaedic surgeons. A Visual Analogue Scale (VAS) was used to determine the intensity of the pain felt during reduction.

Results: The groups were statistically comparable (age, male/female ratio, mechanism of dislocation, mean time interval between injury and first attempt of reduction). Reduction was achieved with the “Fares” method in 88.6%, with the “Hippocrates” in 72.5% and with the “Kocher” in 68% of the patients. This difference was statistically significant, favoring the “Fares” method (p=0.033). The mean duration of the reduction (p=0.000) and the mean reported by the patients VAS with the “Fares” method (p=0.000) were also statistically significantly lower than those of the other methods. No complications were noted in any group.

Discussion: The “Fares” method was statistically proven to be a significantly more effective, faster and less painful method of reduction of the anterior shoulder dislocation, when compared with the “Hippocrates” and the “Kocher” methods. It is easily performed by only one physician, it is applicable both to anterior shoulder dislocations and fractures-dislocations and it is not more morbid that the other two methods.