A Retrospective Audit of the Management of Shoulder Dislocations at a Trauma Unit

Shoulder dislocation is the most common major joint dislocation encountered in our emergency department, with anterior dislocation accounting for the vast majority. This retrospective audit evaluates adherence to the health board guidelines for managing traumatic shoulder instability at Grange University Hospital.

Data from 100 patients presenting with native shoulder dislocations between January 2021 and February 2024 were analyzed. Clinical notes, radiological records, and procedural details were reviewed to assess compliance with imaging protocols, reduction procedures, and follow-up care.

The mean patient age was 44 years, with a female predominance of 52% (52 out of 100). Anterior dislocations constituted 83% of cases (83 patients), with posterior and inferior dislocations accounting for 16% (16 patients) and 1% (one patient), respectively. Manipulation under anaesthesia (MUA) was successful in 98% of cases (98 out of 100 patients), while 2% (two patients) required open reduction. Pre- and post-reduction imaging was performed in 97% of patients. Computed tomography (CT) and magnetic resonance imaging (MRI) were frequently used to assess associated injuries, which included Hill-Sachs lesions, greater tuberosity fractures, and rotator cuff tears. Neurological complications were identified in 28 patients (28%), primarily involving the axillary nerve. Posterior dislocations were more prevalent than typically reported, suggesting heightened diagnostic awareness.

This audit demonstrates strong compliance with established clinical protocols, reflected in high MUA success rates and effective identification of injury-related complications. However, areas for improvement have been identified to further improve clinical management and patient satisfaction.