We propose pragmatic approach to the initial treatment of fracture dislocations of shoulder. In type I injury, where there is an anterior dislocation with greater tuberosity fracture, one should attempt a reduction under sedation; 94% of attempted reductions under sedation were successful and no fracture propagation occurred. In case of a type II injury, when the fracture is involving a surgical neck of the humerus with or without greater tuberosities fracture, our experience suggests that no attempt of reduction is undertaken under sedation and patient has general anaesthetic. Posterior dislocation with any fracture remains an unsolved problem, but in our series no attempt of reduction under sedation was made.
We suggest that these easily identifiable predictors present on admission can be used to identify patients at high risk and guide management by a multidisciplinary team. Cite this article: Bone Joint J 2017;99-B:116-21.
patient. We use 5 ml of methylene blue dye added to the volume of saline prior to peri-operative infiltration of the implant. In the clinic, this allows a visible aspiration into a butterfly needle and syringe (Fig. 1), confirming rapidly that the needle is correctly sited within the port, and that expansion or deflation can proceed. Although it has been suggested that an immediate postoperative radiograph after hip arthroplasty is not needed, 1 we favour one, principally to confirm reduction and exclude any intra-operative fracture. The patient is kept in the lateral position following arthroplasty. A pillow is placed between the patient's knees to abduct the hip. The back support is loosened and the X-ray plate is positioned behind the hip. A radiograph is then obtained as
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.