Survey Of The Management Of Acute Traumatic Unilateral First-Time Anterior Shoulder Dislocation (AFSD) Among Orthopaedic Surgeons In USA

摘要

Aim: To identify the current trend in managing acute traumatic first-time anterior shoulder dislocation (AFSD) among orthopaedic surgeons in USA and to draw comparisons with previous UK study1.Design: Postal Questionnaire among Orthopaedic Surgeons in Northern America.Method: 200 questionnaires were sent out to a random list of active members of The American Orthopaedic Society for Sports Medicine (AOSSM) throughout USA. Questions were laid out in two 'workgroups'. Basic demographic data such as type of practice and surgical specialisation were recorded. In 'Workgroup One' questions regarding method and duration of immobilisation were analysed. In 'Workgroup Two', two case scenarios stratified by age, were analysed to look into the 'post-reduction' management, focusing on trend in technique of stabilisation employed.Results: The response rate was 55% (109 of 200). 26 percent of respondents derived from academic practices and the remaining 74% of respondents were from privatised institution. Majority of the respondents were regarded as 'surgeons with special interest in sports medicine' (87 of 109, 80%). This was followed by 'shoulder and elbow surgeons' and 'general orthopaedic surgeons' (12% and 8% respectively). The most popular choice of immobilisation was internal rotation (72.5%). However, 24.8% of respondents preferred the external rotation method for immobilisation as advocated by Itoi et al. The mean duration of immobilisation was 2.5 weeks (1/2 weeks to 8 weeks, Std Deviations 1.2weeks). 42.2% (46 of 109) of respondents would perform an immediate arthroscopic stabilisation in young, fit patients presenting with this type of injury. On the other hand, an overwhelming majority of the respondent opted for non-operative management in older patient presented with this problem (98%). The current trend of management in the young, active age group comprised of arthroscopic stabilisation using suture anchors, followed by immobilisation in internal rotation for average 3-4 weeks and return to sports/work at average 5 months post-surgery. Conclusion: This survey revealed variations among orthopaedic surgeons in managing AFSD on the 'front-line' within USA. There are also observational differences between the findings of this and the UK study previously published. There is a need to address the issue of immobilisation technique. Majority of surgeons used age as a criterion in determining definitive management for this injury. The current trend in managing AFSD in young and active patient who presented with AFSD is arthroscopic stabilisation using suture anchors. Introduction Acute first-time anterior shoulder dislocations (AFSD) are frequent attendants to Casualty departments. The incidence of primary anterior dislocation is estimated to be around 12/100 0001. Despite this, a consensus on management protocol is still lacking throughout the developed world1,13. A recent report by the second author highlighted this problem in the UK. In our discussion at the end of the paper, we commented on our interest to see whether our colleagues in the USA had a common treatment regime in place. As a follow up to that, we conducted a questionnaire survey among a sample number of members of the AOSSM(American Orthopaedic Society of Sports Medicine). The aim of this survey was to find out how AFSD after closed reduction is managed among US orthopaedic surgeons who manage this problem in the current clinical setting. We also aim to highlight certain clinical issues regarding the management of AFSD. The latter relates to recent studies coming out of Japan and Australia, which have advocated the use of immobilisation in external rotation following reduction of anterior shoulder dislocation. 3,4,5. We aim to find out whether this nouvelle method of immobilisation had filtered through US orthopaedic surgeons. A third mention was to find out what the current trend in the management of AFSD differed for 2 distinct age groups. Observational comparisons