The authors introduce a new method for the closed reduction of anterior dislocation of the shoulder. Seventy-one patients with age range between 18 and 73 years were included in this prospective study. Sixty patients had pure anterior dislocation of the shoulder and eleven patients had an accompanied fracture of the greater tuberosity. Reduction of the shoulders was performed by first and second-year orthopaedic residents. Three methods were used for reduction; the new relaxed method, Kocher and the traditional Hippocrate’s methods. Residents were free to choose the type of method for reduction. The new relaxed method was performed while the patient was lying on his back and was fully relaxed. No sedation, or analgesics were used. While the arm was on side and the elbow extended, gentle longitudinal traction accompanied by continuous abduction was applied. Continuous vertical oscillation of the upper arm was applied simultaneously as the arm was brought gently into abduction. After 90 degrees of abduction the arm was externally rotated and abduction was continued gently to about 120 degres where reduction of the shoulder was expected. The new relaxed method was successfully used 28 times out of 34 attempts. The Kocher method was also successfully used 13 times out of 22 attempts and the Hippocrate’s method 10 times out of fifteen attempts. The new painless and smooth method for reduction of anterior dislocation of the shoulder is an effective, non-traumatic procedure that can be performed easily without the use of sedation or analgesia

We present a surgical technique through an axillary incision to perform scapular neck osteotomy and insertion of bone graft for recurrent anterior dislocation of shoulder. Fifty patients in the age group 09–40 years with the history of anterior dislocation of shoulder more than three times were operated during 1988–1998. The dominant shoulder was involved in all cases and there was no history of epilepsy, addiction to drugs and psychosomatic ailments. The surgery was performed through an axillary incision. The lateral border of the scapula was palpated and infraglenoid tubercle identified. The scapular neck was osteotomised parallel to the glenoid margin, from infraglenoid tubercle to the lateral border of the base of coracoid leaving the superior cortex intact. The osteotomy was prised open and a 3 cmx1.5 cmx1 cm corticocancellous bone graft was wedgedwhich projected 10 mm anteriorly and 6 mm inferiorly. The graft remained secure and compressed in the osteotomy without any need of metallic fixation.The shoulder was immobilised in arm chest bandage for 4 weeks followed by mobilisation aimed to regain full movements in 12 weeks. The bone graft got incorporated in all patients in 6 months.There were no recurrence at follow up of 2–10 years. All the patients returned to their previous occupation. Rowes shoulder evaluation revealed excellent result (85–100 units). This surgical technique is extra-capsular, requires no muscle cutting, blood transfusion or metallic fixation. The projecting bone block anteriorly increased the depth of glenoid resulting in glenohumeral stability in larger arc of shoulder movements

Background. Acute anterior dislocation of the glenohumeral joint may be complicated by injury to neighboring structures. These injuries are best considered a spectrum of injury ranging from an isolated dislocation (unifocal injury), through injuries associated with either nerve or osteoligamentous injury (bifocal injury), to injuries where there is evidence of both nerve and osteoligamentous injury. The latter combination has previously been described as the “terrible triad,” although we prefer the term “trifocal,” recognizing that this is the more severe end of an injury spectrum and avoiding confusion with the terrible triad of the elbow. We evaluated the prevalence and risk factors for nerve and osteoligamentous injuries associated with an acute anterior glenohumeral dislocation in a large consecutive series of patients treated in our Unit. Materials and Methods. 3626 consecutive adults (mean age 48yrs) with primary traumatic anterior shoulder dislocation treated at our unit were included. All patients were interviewed and examined by an orthopaedic trauma surgeon and underwent radiological assessment within a week of injury. Where rotator cuff injury or radiologically-occult greater tuberosity fracture was suspected, urgent ultrasonography was used. Deficits in neurovascular function were assessed clinically, with electrophysiological testing reserved for equivocal cases. Results. Unifocal injuries occurred in 2228 (61.4%) of patients. There was a bimodal distribution in the prevalence of these injuries, with peaks in the 20–29 age cohort (34.4% patients) and after the age of 60 years (23.0% patients). Of the 1120 (30.9%) patients with bifocal dislocations, 920 (82.1%) patients had an associated osteotendinous injury and 200 (17.9%) patients had an associated nerve injury. Trifocal injuries occurred in 278 (7.7%) of cases. In bifocal and trifocal injuries, rotator cuff tears and fractures of the greater tuberosity or glenoid were the most frequent osteotendinous injuries. The axillary nerve was most frequently injured neurological structure. We were unable to elicit any significant statistical differences between bifocal and trifocal injuries with regards to patient demographics. However, when compared with unifocal injuries, bifocal or trifocal injuries were more likely to occur in older, female patients resulting from low energy falls (p<0.05). Conclusions. We present the largest series reporting the epidemiology of injury patterns related to traumatic anterior shoulder dislocation. Increased understanding and awareness of these injuries among clinicians will improve diagnosis and facilitate appropriate treatment

We conducted a prospective evaluation of patients with anterior dislocation of the shoulder associated with a fracture of the greater tuberosity. Thirty-four anterior dislocations of the shoulder with greater tuberosity fractures were reviewed with a minimum follow-up of one year from the time of injury. Eight required open reduction. The final outcome with regard to pain, range of movements, and function was assessed in 34 patients. In open reduction, there were five good results, one fair, one poor and one patient died. In the non-operative group, results were good in 11 patients, fair in eight, poor in one, not assessed in five and one patient died. Two patients have died in this series, one in the open reduction group. Associated injuries are: axillary nerve damage (three), brachial plexus injury (one), loose fragment under the acromion (one) and stiffness of the shoulder (three). Anterior dislocations of the shoulder with fracture of the greater tuberosity do not always lead to good results. Close observation after reduction is important to check for later displacement of the fractures

Aim of this prospective, randomized study is to introduce and compare a new technique of reduction of the anterior dislocation of the shoulder 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. This is the first reported prospective, randomized comparative study of three reduction techniques of anterior dislocations of the shoulder. 154 patients suffering from acute anterior shoulder dislocation participated in the study. Patients were randomly assigned to one of the three study groups (New, “Hippocrates” and “Kocher”) and underwent reduction of their dislocation performed by residents orthopaedic surgeons. 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 new method (p=0.033). The mean duration of the reduction (p=0.000) and the mean reported by the patients VAS with the new method (p=0.000) were also statistically significantly lower than those of the other methods. No complications were noted in any group. The new method seems to be 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 and it is not more morbid that the other two methods

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

First-time anterior dislocation of the shoulder is associated with the development of recurrent instability. It is recognised that patients with recurrent instability often have osseous defects. Using 3D computerised tomography (3DCT) it is possible to quantify these defects. Whether these defects are present after the primary dislocation or occur progressively from multiple dislocations is unclear. We correlated the presence of Hill-Sachs lesions and anterior glenoid bone loss with evidence of recurrent dislocation and clinical outcomes. 78 patients were followed up for two years. All underwent a 3DCT within a week of injury. Standardised images of the humeral head and glenoid were produced. Using standardised digital techniques bone loss was measured. 39% of the patients developed further instability. Average Hill-Sachs circumferential length = 15.23%. Average Hill-Sachs surface area = 5.53%. The length and surface area of the Hill-Sachs lesions were significantly associated with further instability. (p=0.019 and p=0.003). Average en face glenoid surface area loss=1.30% with no association to instability (p=0.685). There was poor correlation between the size of the glenoid lesion and the size of the Hill-Sachs lesion. Results showed that age and increasing size of the Hill-Sachs lesions result in a higher rate of instability. Interestingly glenoid bone loss was relatively low and did not predict recurrent instability. The size of the Hill-Sachs lesion does not have a linear relationship with glenoid bone loss. Further work defining the morphology of the Hill-Sachs lesion and its engagement with a glenoid defect is required

Many techniques exist for reduction of anterior dislocation of the shoulder. The two commonest methods are the Hippocratic and Kocher. Iatrogenic complications have been linked to both techniques; though reports of brachial plexus traction-injury from the Hippocratic method are rare compared to the more common complication of surgical neck of humerus fracture secondary to the Kocher technique. Method Questionnaires were sent to 125 Orthopaedic and 125 A& E departments in the UK, asking staff to independently comment on their preferential reduction technique in anterior dislocation of the shoulder. Results Overall 62% performed the Kocher method and 29% performed a Hippocratic reduction. However, 64% of Orthopaedic consultants performed a Hippocratic reduction (34% performing Kocher) compared to only 14% of A& E consultants, (70% of whom performed a Kocher reduction). Conclusion The significant risk of humeral neck fracture in performing a Kocher reduction, especially in an inadequately anaesthetised patient in the A& E setting, and the overwhelming preference of Orthopaedic consultants to perform a Hippocratic reduction, indicate that the Kocher method should not be employed

Aims

The aim of this study was to identify the optimal lip position for total hip arthroplasties (THAs) using a lipped liner. There is a lack of consensus on the optimal position, with substantial variability in surgeon practice.

Traumatic anterior shoulder dislocation and sub-luxation are common injuries. But few studies have compared arthroscopic and open stabilization of the shoulder at long-term follow up. The purpose of our study is to show whether an arthroscopic approach to repair Bankart lesion can obtain the same results at long follow up as an open procedure. We analyzed 110 non-randomized consecutive shoulders in 110 patients who underwent a surgical repair of recurrent anterior shoulder instability between 1990 and 1999. Eighty-two patients were available at long term follow up (74,5% retrieval rate). In particular, 49 patients (59.8%) (group A) were treated with arthroscopic transglenoid suture (modified Caspari) between 1990 and 1995 (mean 15,7 year FU), whereas, 33 patients (40.2%) (group B) were treated with open repair between 1995 and 1999 (mean 12,7 year FU). We evaluated the patients in terms of failure rates, Rowe and UCLA scores. The failure cases in the forty-nine patients treated with arthroscopic suture were 13, six dislocations and seven subluxations. The group A had also a Rowe score: function 24.2+8.2, stability 42.4+13.9, range of movement 18.6+3.8, total score 85.0+22.46. The UCLA score was: pain 8.8+1.7, function 8.6+2.1, muscle power 9.2+1.6, total score 26.4+4.8. Of the thirty-three patients treated with open repair, three had at least one post-op dislocations and four felt sometimes subluxations. The Rowe score in group B was: function 23.6+9.7, stability 41.2+14.9, range of movement 18.3+3.9, total score 83.2+24.4. Moreover the UCLA score was: pain 8.8+1.9, function 8.8+1.9, muscle power 9.2+1.2, total score 26.9+4.2. We showed that both techniques were fairly good in treatment of shoulder instability. In our series no significant difference was observed in redislocation rate and in Rowe and UCLA scores between the two groups. The recurrence rate (subluxations and dislocations) was high in both groups: the arthroscopic group had 26.5% and the open one had 21.2%. Our recurrence rate following open repair was higher than in many studies, while the rate after arthroscopic transglenoid procedure was almost equivalent. We hypothesize that one of the reasons for these higher recurrence rates may be the long term follow up. Another cause could be our decision to include subluxation as a failure value, even if there is no agreement about. In fact we believe it to be an important disability factor in sport as in life activities. After surgery, most of the patients returned to their preinjuried activities. But at long term follow up almost all patients have stopped high level sport activity. Moreover, at this long term follow up, some patients told us a feeling of muscle weakness in the last years. In conclusion patients had good impressions about their shoulders thanks to surgery, but also because of lower functional demand

[Hong Kong Orthopaedic Association, Travelling Fellow]. Glenoid bone loss predisposes to further dislocation and failure of arthroscopic Bankart repair in patients with recurrent shoulder dislocation. This study investigates quantification of glenoid bone loss in anterior shoulder dislocation using computerized tomography (CT). CT was performed in 40 patients (average age 31 years, range 16–82 years) with anterior shoulder dislocation. Of this group, 42 shoulders with anterior dislocation and 38 contralateral normal shoulders were examined. In addition, twenty shoulders in ten normal subjects were examined. CT technique comprised 1mm acquisition, pitch 1.0, simultaneously of both shoulders. Reformatted images en face to the glenoid fossa were obtained. Ten different measures of the glenoid fossa were obtained including cross sectional area, maximum height, and width and flattening of the anterior curvature of the glenoid. In normal subjects, maximum side to side difference in cross-sectional area was 14% and maximum glenoid width 4.1mm. For dislocating shoulders, flattening of the anterior edge of the glenoid fossa and a reduction in maximum glenoid width were the best objective criteria of bone loss. Flattening of the anterior glenoid curvature was a feature of 95% dislocated shoulders though was only seen in 1.5% of normal shoulders. Glenoid cross-sectional area was not a useful measure of glenoid bone deficiency. Variable glenoid bone loss is a measurable feature of anterior shoulder dislocation. CT can be used to objectively assess this preoperatively. This should help when deciding on whether to perform an arthroscopic Bankart repair or open bone block procedure

Introduction: This study was performed to assess the incidence of generalized ligament laxity in patients presented with 1st time anterior shoulder dislocation. Patients and Methods: Prospective data was collected for patients presented with 1st time anterior shoulder dislocation and clavicle fracture as a control group between Aug 2008 and Feb 2009 under the care of a specialist shoulder surgeon. Data included demographic details, mechanism of injury and generalized ligament laxity using Beighton score. Laxity is scored on a 0–9 scale. Scores of 4 or above are indicative of generalized ligament laxity. Brighton criteria was used to diagnose Benign Joint Hypermobility Syndrome (BJHS). Results: Data was collected for 44 patients with first time anterior shoulder dislocation and 43 patients with clavicle fracture. There was no difference in the demographics of the groups. There were 40 male (91%) and 4 (9%) female patients in the dislocation group. Mean age was 25 years with a range from 15–55. Most common cause of shoulder dislocation was sports related injuries in 26 patients (60%). The average Beighton score for dislocation group was 3.6 with a range from 0–9 as compared to 2.1 with a range from 0–7 in the control group. Twenty one patients (48%) in the dislocation group had a Beighton score of 4 or more indicating generalized ligament laxity as compared to 12 patients (28%) in the control group. This difference was statistically significant with a P value of 0.009. Six patients (14%) fulfilled the Brighton criteria for BJHS in the dislocation group as compared to 3 patients (7%) in the control group. Conclusion: We found that there is a high incidence (48%) of generalized ligament laxity in patients presented with first time anterior shoulder dislocation. Appropriate advice should be given to these patients about rehabilitation, risk of recurrent dislocations and timing of shoulder stabilization

Introduction: Various surgical methods have been described to manage the problem of recurrent anterior dislocation of the shoulder. Older procedures Putti-Platt’s, Magnuson-Stack’s or Bristow;’s and Boytchev’s repair are not used today due to a high percentage of failure of 7%–17% incidence of recurrence associated with limited ROM. However, in the last decade the goal of treatment has changed. It is directed now towards restoration of normal function with full ROM of the affected shoulder, based mainly on arthroscopic stabilization or on “open” Neer’s capsular shift procedures combined with Bankart’s repair. However, during the last few years there are more and more papers dealing with a surprising unexpected high number of patients with shoulder instability following arthroscopic repair. The purpose of this study is to review the long term results of “open” Neer’s capsular shift procedure. Materials & Methods: This is a presentation of 87 (78M; 9F) consecutive patients, 19 to 47 year old (mean 23 Y) with a length of follow-up of 4Y–15Y (mean 6Y). 45 of them with traumatic recurrent anterior dislocation of the shoulder had a capsular shift procedure according to Rockwood’s modification. In 42 other patients that had a multidirectional instability with proved dislocations of the affected shoulder a Protzman’s modified capsular shift procedure was used. Results: 82/87 patients had a stable shoulder without recurrent dislocation. 3 patients had an episode of traumatic shoulder dislocation within 2 months following operation. Two other patients of 42 with multidirectional instability had a recurrence of traumatic dislocation. One patient developed partial brachial plexus injury, most probably due to traction of the affected limb following operation. 78/87 had at follow-up normal shoulder function with full ROM, and the remaining 9 patients had only a slight limitation in shoulder abduction and in external rotation. Conclusions: Based on this study, it is suggested that capsular shift procedure is an excellent method for repair of recurrent anterior shoulder dislocation, preferable to the “older” procedures, and allows restoration of shoulder stability with better functional results. This is suitable mainly for patients with structural hyperlaxity and multidirectional instability, whereas arthroscopic stabilization might be used in patients with true traumatic instability

Introduction. Chronic aquired anterior dislocation of the radial head, Bado type I Monteggia equivalent lesion is a uncommen occurence in children. We present our results of sixteen childrn treated with an angular corrective osteotomy. Material and methods. Sixteen children, mean age at the time of injury was six years and eight years at the time of surgery. Time from dislocation to diagnosis was median 30 weeks. Preoperatively decreased range of motion was detected. All children underwent angular ulnar osteotomy using Boyd-Thompson approach. The osteotomy was fixed using a single Steinmann pin. Long arm cast was applied until radiographic healing was detected. Results. Follow-up showed all but one had successful reduction. Non-union was not detected. All children were pain free at follow up. The total flexion-extension arc of motion measured median 135 degrees. Total rotation of forearm measured median 145 degrees. Conclusion. Correct treatment of Monteggia equivalent lesionsare demanding. Both in relation to obtaining the correct diagnosis without delay as well as the best treatment procedure. Full antebrachium X-rays are recommended in order to get exact diagnosis initially. Corrective angular ulnar osteotomy is recommened as soft tissue procedures alone is insufficient for alignment of the elbow

Purpose: To determine whether generalized ligamentous laxity is a predisposing factor for primary traumatic anterior shoulder dislocation in young, active patients. Method: Prospective case series with age and sex matched controls. The Hospital Del Mar Criteria was utilized to measure generalized ligamentous laxity. Fifty-seven (n=57) consecutive individuals (age< 30) sustaining a primary traumatic anterior shoulder dislocation between 2003 and 2006 were examined for hyperlaxity. The control group was comprised of seventy-two (n=72) undergraduate university students without a prior history of shoulder dislocation or anterior cruciate ligament injury. Results: After adjusting for age and sex, the prevalence of hyperlaxity in the study group was 32.8% compared with 10.4% in the control group (p< 0.01). The prevalence of increased contralateral shoulder external rotation (> 85o) was 40.3% in the study group compared with 20.8% in the control group (p< 0.03). Among males, the prevalence of hyperlaxity was 28.3% in the study group and 5.3% in the controls (p< 0.01). Conclusion: Although several studies have looked at the variables affecting shoulder instability, generalized ligamentous laxity (as measured by validated criteria) has not previously been identified as a predisposing factor for primary traumatic shoulder dislocation. This study demonstrates that generalized joint laxity and increased external rotation in the contralateral shoulder were found to be more common in patients who had sustained a primary shoulder dislocation. These observations may suggest a role for shoulder-specific proprioceptive and strength training protocols in hyperlax individuals participating in high-risk sports. Furthermore, the implications of hyperlaxity on the surgical management of traumatic primary shoulder instability are uncertain

In the international literature, the rate of recurrence after conservative treatment of traumatic anterior dislocation of the shoulder joint is high. Rates are highest in young subjects and violent sports. Recent publications report a lower rate of recurrence after immobilization in external rotation but with a short follow-up and in heterogeneous groups where contact sports were not individualized. Between August 1989 and April 1997, we conducted a prospective study to assess outcome in contact sports athletes aged at least 30 years (arthroscopy, 2001) Comparing the results of surgical and non-surgical treatment showed excellent or good outcome in 96% of the surgery group and in 94% of the non-surgery group. Later publications showed that chronic disease is an important negative factor for bone and cartilage tissue quality at repair. Between August 1989 and March 2005, we have performed 97 first-intention arthroscopic repair procedures in contact sport athletes and have obtained anatomic repair more easily with better quality tissue and better outcome with a lower rate of recurrence as well as more rapid resumption of training

Aim: To survey how acute, traumatic, first-time anterior shoulder dislocation (AFSD) is managed amongst trauma clinicians in the current clinical setting in UK hospitals. Design: Postal Questionnaire. Method: 228 questionnaires were sent out to list of active consultant member of the British Trauma Society practising in various hospitals around United Kingdom. Questions were laid out in two workgroups. In work-group one, an assortment of questions were asked with the emphasis on management in AFSD from the point of entry in a casualty department to departure and after-care. In workgroup two, case scenarios were included to look in the ‘aftercare’ management in three distinct age groups; young (< 25 years old), middle age (30–65 years old) and elderly (> 65 years old). Results: The response rate of the questionnaires was 51%. Twenty-two per cent of respondents have local protocol for managing AFSD. All respondents recommended pre-and post-reduction X-rays as standard practice. Most respondents favoured systemic analgesia with ‘airways monitoring’, as opposed to intra-articular anaesthesia (68 versus 9). Kocher and Hippocrates were the most popular methods of reduction. Eighty-four respondents advocated immobilisation in internal rotation compared to six in external rotation. Only a small number of respondents would perform an immediate arthroscopic stabilisation in young, fit patients presenting with this type of injury (16 of 84). Conclusion: This survey revealed the current practice of trauma clinicians in managing AFSD on the ‘front-line’. We conclude that there is significant variation in response to the issues incorporated in this survey. There is a need to address the issues of intra-articular analgesia, immobilisation technique and management of AFSD amongst young patient with regards to immediate surgical intervention. We suggest that these issues be revised and clarified, ideally in a randomised controlled clinical trial prior to the introduction of a protocol for managing this problem

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

To discover how traumatic anterior shoulder dislocation in the young patient (17–25) is managed by shoulder surgeons in the UK. A comprehensive postal questionnaire was sent to 164 orthopaedic consultants, all members of BESS. 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 recur- rent traumatic dislocaters. The response rate was 82% (n=135). The most likely treatment of a young traumatic shoulder dislocation:. It will be reduced under sedation in A& E by the A& E doctor. Apart from x-ray, no investigations will be performed. It will be immobilised for 3 weeks, then given course of physiotherapy. 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. 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, 18% said their first choice operation would be arthroscopic stabilisation, the number of dislocations normally permitted before surgery ranged from 1 to more than 4, and the period of immobilisation post operation from nil to 6 weeks. We now know how shoulder surgeons in the UK are treating this common injury. The results reveal that in Britain, we do not have a consistent approach, raising many discussion points. Open stabilisation remains the firm favourite. Does this mean arthroscopic stabilisation is regarded as an experimental procedure?

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 used in 2003 and 2009, sent out to 164 members of British Elbow and Shoulder Society. Questions were asked about the initial reduction, investigation undertaken, timing of any surgery, preferred stabilization procedure, arthroscopic or open, detail of surgical technique, period of immobilization and rehabilitation programme instigated in first-time and recurrent traumatic dislocators. Summary of Results: The response rate were 92% (n=151) – 2009, 83% (n=131) – 2003 The most likely management of a young traumatic shoulder dislocation in the UK would be:. Reduction under sedation in A& E by the A& E doctor (80% of respondents). Apart from X-ray, no investigations are performed (80%). Immobilisation for 3 weeks, followed by physiotherapy (82%). 68 % of respondents would consider stabilisation surgery for first time dislocators (especially professional sportsmen) compared to 35% in 2003. Out of them nearly 90% would perform an arthroscopic stabilization vs. 57.5% in 2003. 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% in 2003 that would chose to investigate. 77% would choose to perform arthroscopic stabilisation compared to 18% in 2003, the commonest procedure being arthroscopic Bankart repair using biodegradable bone anchors (62% compared to 27% in 2003). Following surgery, immobilisation would be for 3 weeks, full range of motion at 1 to 2 months and return to contact sports at 6 to 12 months. Conclusions: 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 2003