Delays to initial reduction attempt are associated with higher failure rates in anterior shoulder dislocation: a retrospective analysis of factors affecting reduction failure

Delays to initial reduction attempt are associated with higher failure rates in anterior shoulder dislocation: a retrospective analysis of factors affecting reduction failure

  1. Avinash Kanji1,2,
  2. Paul Atkinson2,3,4,5,
  3. Jacqueline Fraser3,4,
  4. David Lewis2,3,
  5. Susan Benjamin2,5

+Author Affiliations

  1. 1Faculty of MedicineUniversity College CorkCork, Ireland

  2. 2Department of Emergency MedicineHorizon Health NetworkSaint John, New Brunswick, Canada

  3. 3Department of Emergency MedicineDalhousie UniversitySaint John, New Brunswick, Canada

  4. 4Discipline of Emergency MedicineMemorial UniversitySaint John, New Brunswick, Canada

  5. 5New Brunswick Trauma ProgramSaint John Regional HospitalSaint John, New Brunswick, Canada
  1. Correspondence toDr Paul Atkinson, Professor, Department of Emergency Medicine, Dalhousie University, Saint John Regional Hospital, 400 University Avenue, Saint John, New Brunswick, Canada E2L 4L4; [email protected]
  • Received 17 February 2015
  • Revised 8 June 2015
  • Accepted 9 June 2015
  • Published Online First 25 June 2015


Introduction Little is understood about the relationship between delay to treatment and initial reduction success for anterior shoulder dislocation. Our study examines whether delays to initial treatment, from injury and hospital presentation, are associated with higher reduction failure rates for anterior shoulder dislocation.

Methods A retrospective database and chart review was performed for patients undergoing intravenous sedation for attempted reduction of anterior shoulder dislocation in the emergency department (ED). Stepwise regression analysis was performed to identify predictors of reduction failure. Key variables analysed were the duration of the wait in the ED, the interval between the time of injury and first intervention and the interval from time of injury to arrival at the ED. Possible confounding variables analysed included age, gender, dose of sedative agent, qualifications of the reducing physician and whether the dislocated shoulder was recurrent.

Results The duration of the intervals from injury to first reduction attempt and from arrival at the ED to first reduction attempt were both independent predictors of a higher reduction failure rate (OR=1.07, 95% CI 1.02 to 1.13; OR=1.19, 95% CI 1.05 to 1.34). Every interval of 10 min increased the odds of a failed reduction attempt by 7% and 19%, respectively. Overall, shoulder reduction was successful during the initial sedation event in 97 cases (92%) and unsuccessful in nine cases (8%).

Conclusions Delays to first reduction attempt either from the time of injury or within the ED are associated with a lower reduction success rate for anterior shoulder dislocations.

Key messages

What is already known on this subject?

  • Anterior shoulder dislocations are a common joint dislocation seen in the emergency department (ED). The failure rate for closed reduction in the ED is low. Although these injuries are triaged as urgent, there is little published evidence describing the impact of timely reduction on success rates for closed reduction.

What might this study add?

  • This retrospective study of patients undergoing procedural sedation for anterior shoulder dislocation found an association between treatment delays and initial reduction failure rates. The results of this study support the established ‘truism’ that these injuries should be treated as quickly as possible after arrival to the ED.

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