Abstract
Aims
To discover how the management of traumatic anterior shoulder dislocation in the young patient (17-25) has changed, if at all, over the past six years.
Methods
The same postal questionnaire was sent in 2002 and 2009 to 164 shoulder surgeons. Questions were asked about initial reduction, investigation undertaken, timing of surgery, preferred stabilisation procedure, period of immobilisation and rehabilitation programme instigated in first-time and recurrent traumatic dislocators.
Summary of Results
Response rate - 92% (2009), 83% (2002). The most likely management of a young traumatic shoulder dislocation:
Reduction under sedation in A&E by A&E doctor (80%)
Apart from X-ray, no investigations are performed (80%)
Immobilisation for 3 weeks, followed by physiotherapy (82%)
68% would consider stabilisation surgery for first time dislocators (especially professional sportsmen) compared to 35% (2002)
Of them, nearly 90% would perform an arthroscopic stabilisation vs. 57.5% (2002).
For recurrent dislocators:
75% would consider stabilisation after a second dislocation
85% would investigate prior to surgery, choice of investigation being MR arthrogram (52%), compared to 50% (2002)
77% would perform arthroscopic stabilisation vs. 18% (2002), commonest procedure-arthroscopic Bankart repair using biodegradable bone anchors (62% 2009 vs. 27% in 2002)
Immobilisation for 3 weeks, full range of motion 1-2 months and return to contact sports 6 - 12 months.
Conclusion
There has been a remarkable change in practice compared to the previous survey. A significant proportion of Orthopaedic Surgeons would consider stabilisation in young first-time dislocators instead of conservative management. Arthroscopic stabilisation is now the preferred technique compared to open stabilisation whenever possible. Surgeons are using more investigations prior to listing the patient for surgery, namely the MR arthrogram. There is also an increased use of bio-degradable anchors as compared to metallic bone anchors in 2002.
