Immobilization in external rotation after primary shoulder dislocation reduces the risk of recurrence in young patients. A randomized controlled trial

Murray, Jean-Christophe; Leclerc, Alexandre; Balatri, Amerigo; Pelet, Stéphane

doi:10.1016/j.otsr.2018.10.007

Cited by 22 publications

(38 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There were 668 male and 149 female patients, and the mean age of patients ranged from 20.3 to 37.5 years. We noted that 5 studies 2,5,9,16,20 had a minimum 24-month follow-up, 1 study 39 entailed more than 12 months of follow-up, 1 study 34 had more than 6 months of follow-up, and the remaining 2 studies 21,37 were without description. Regarding these 2 studies, Nagaraj et al 21 included 31 male and 11 female patients with a mean age of 37.5 years, and Wang et al 37 included 77 male and 16 female patients with a mean age of 26 years.…”

Section: Resultsmentioning

confidence: 99%

“…The current meta-analysis included 5 RCTs, 5,9,16,20,39 1 quasi-RCT, 34 and 3 studies 2,21,37 that could not be distinguished as RCT or quasi-RCT. Overall, 817 patients were included and divided into 2 groups: 416 patients immobilized in ER and 401 patients immobilized in IR.…”

Section: Resultsmentioning

confidence: 99%

“…Further subgroup analyses were performed without the low-compliance or unknown-compliance studies. In 4 studies, 5,9,20,34 outcomes of nonsurgical treatment were described in patients aged 20 to 40 years and those younger than 20 years. In the 20- to 40-year cohort, the recurrence rate was significantly lower in the ER group than the IR group ( P < .0001) (Figure 6).…”

Section: Resultsmentioning

confidence: 99%

“…3,13,17,36,38 We adopted the literature search method used in a recent meta-analysis. 38 Subsequently, we added 3 RCTs that had not been included in the previous studies 20,21,37 and could update the outcomes of the meta-analysis. The current meta-analysis including 9 RCTs has demonstrated that ER immobilization reduces recurrence rate by 44% compared with IR immobilization.…”

Section: Discussionmentioning

confidence: 99%

“…3,13,17,36,38 Recently, a new RCT was added to the literature. 20 Thus, we sought to update our knowledge about the efficacy of immobilization in ER. The purpose of this study was to determine the efficacy of ER versus IR immobilization on recurrence rate after primary dislocation of the shoulder.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Immobilization in External Rotation Reduces the Risk of Recurrence After Primary Anterior Shoulder Dislocation: A Meta-analysis

Shinagawa

Sugawara

Hatta

et al. 2020

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: The best method for nonsurgical treatment after primary dislocation of the shoulder is not clear. The efficacy of immobilization with the arm in external rotation (ER) compared with internal rotation (IR) remains controversial. Purpose: To determine the efficacy of ER immobilization versus IR immobilization on recurrence rate after primary dislocation of the shoulder from the evidence of randomized controlled trials. Study Design: Systematic review; Level of evidence, 2. Methods: Electronic databases (MEDLINE [Ovid SP], PubMed, Web of Science, EBM reviews, and CINAHL) and available proceedings according to the abstracts of major international meetings related to or including shoulder injuries and trauma were used to search for randomized controlled trials. Two independent investigators determined eligibility and carried out data extraction from the selected studies. Results: A total of 9 studies (817 patients) were selected for this meta-analysis. They included 668 male and 149 female patients, with a mean age ranging from 20.3 to 37.5 years. In the 9 pooled studies, the recurrence rate of shoulder dislocation was 21.5% (84/390) in the ER group versus 34.9% (130/373) in the IR group. ER immobilization significantly reduced the recurrence rate compared with IR immobilization (risk ratio, 0.56; P = .007). In the subgroup analysis of those immobilized full-time, ER immobilization was significantly more effective than IR immobilization in reducing the recurrence rate (risk ratio, 0.57; P = .01). In the subgroup analysis of age, ER immobilization was significantly more effective than IR immobilization in those aged 20 to 40 years but not in those younger than 20 years. Conclusion: This meta-analysis demonstrates that ER immobilization reduces the recurrence rate after primary shoulder dislocation compared with IR immobilization in patients older than 20 years. When treating a patient with primary shoulder dislocation, the clinician should provide this information to the patient before a treatment method is selected.

show abstract