Abstract
Purpose
Shoulder dislocations account for 50 % of all dislocations, of which 98% are anterior dislocations. Different techniques have been described in literature with variable success, which depends upon type of dislocation, technique used and muscle relaxation.
Method
A retrospective review of data of all shoulder dislocations presented to accident and emergency department over a one-year period was undertaken. Over a 1-year period total of 52 patients presented with mean age of 41 years. Closed reduction was attempted in all patients by accident and emergency department using various techniques and combination of analgesia. Unsuccessful reductions and those with associated fractures were referred to orthopaedics department. This group had closed reduction utilising Sahas zero position technique in accident and emergency department. Post reduction all patients had two views of radiograph to confirm reduction and poly-sling for 2–3 weeks.
Results
We had 37 (71.1%) males and 15(28.8%) females with shoulder dislocations. In our patients 98% were anterior dislocations and 14 % were dislocations associated with fractures. Of 52 patients 33 (63%) were first time dislocations and 17(33%) had recurrent dislocations In cohort of 52 patients 7(13.4%) had neurological deficit prior to reduction, which was sensory hypoesthesia along the regimental badge area, and 1(2%) had a post reduction neurology using modified Milch technique. Most of our patients 38 (73%) were reduced using various techniques for reducing shoulder dislocation. In these 38 patients analgesia varied from Entonox to combination of Entonox with intravenous morphine with or without diazepam.
Our department was referred 14(27%) patients. Seven patients were referred due to failure of reduction where several attempts with different techniques were made and 7 were directly referred due to association of fracture with the dislocations. 14(27 %) of our patients were reduced using zero position of shoulder in first attempt without the need for additional analgesia. Of these 14 patients 7 had complex shoulder dislocation associated with fractures. We had only one failure of reduction using Sahas zero position of shoulder. This patient had recurrent dislocation with large Hill Sachs defect. This was reduced under general anaesthesia using zero position of shoulder as described by Saha.
Conclusion
This study demonstrates that zero position of shoulder described by Saha is safe, effective and easy method for reducing both anterior, posterior and fracture dislocations of the shoulder. Given the principles of reduction in zero position no additional analgesia and traction is required. The feedback from patients in regards to discomfort and pain was also positive. We conclude that this data suggests the routine use of Sahas technique in reducing both simple and complex shoulder dislocations.
