Anterior shoulder dislocations in pediatric patients: are routine prereduction radiographs necessary?

Fractures are reported to complicate anterior shoulder dislocations in up to 50% of adults. For this reason, prereduction and postreduction radiographs are recommended for the routine evaluation of shoulder dislocations in all patients. To date, few data have been reported as to the incidence of fractures or as to the value of prereduction x-rays in pediatric patients with anterior shoulder dislocations.

The objectives of this study were to estimate the incidence of fractures associated with anterior shoulder dislocation in pediatric patients and to examine the value of prereduction radiographs for these patients.

This was a retrospective review of records for pediatric patients who presented to an emergency department (ED), received a diagnosis of anterior shoulder dislocation, and had at least 1 set of shoulder x-rays.

Of 119 patients who met criteria for inclusion in the study, 3 patients (3%) had a fracture identified; 6 patients (5%) had a possible fracture identified. Except for 1 patient with an avulsion fracture who was transferred without a reduction attempt or further x-rays, all patients had their dislocation reduced uneventfully in the ED.

In our sample of pediatric patients with anterior shoulder dislocations due to low-energy injury mechanisms, plain radiography identified a lower incidence of fractures than those reported from adult studies. Pediatric patients with anterior shoulder dislocations clinically apparent after clinical evaluation may not benefit from prereduction radiographs. Forgoing prereduction x-rays might expedite definitive pain relief for patients, lower cost and radiation exposure, and decrease ED length of stay.