Closed reduction techniques for acute anterior shoulder dislocation: a systematic review and meta-analysis

Area of Science:

• Orthopedics
• Sports Medicine
• Trauma Surgery

Background:

• Anterior shoulder dislocations are common, with closed reduction being the primary treatment.
• Current reduction techniques include traction-countertraction, leverage, and scapular manipulation.
• The optimal closed reduction method for acute anterior shoulder dislocations remains undetermined.

Purpose of the Study:

• To systematically review and compare the effectiveness, safety, and pain levels of different closed reduction methods for anterior shoulder dislocations.
• To identify the most advantageous technique based on patient outcomes and procedural efficiency.

Main Methods:

• A systematic review and meta-analysis of randomized control trials (RCTs) were conducted.
• Searches were performed across CENTRAL, MEDLINE, and Embase databases.
• The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Main Results:

• Twelve RCTs involving 1055 patients were analyzed.
• Traction-countertraction methods were marginally less painful (0.86 VAS points) but slower (20s) than leverage methods.
• Scapular manipulation was significantly less painful (1.5-2.3 VAS points) than both leverage and traction-countertraction, though data was limited.

Conclusions:

• Traction-countertraction and leverage methods show no difference in complication rates or overall success.
• Scapular manipulation appears to be the least painful method, warranting further investigation.
• No single method demonstrated superiority in overall reduction success rate.