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Orthogonal Radiographs After Shoulder Reduction: Are We Meeting the Standard?

Uday Mahajan¹, Muhammad Yousaf¹, Kehinde Jinadu²

¹Trauma and Orthopaedics, Queen Elizabeth Hospital Birmingham, Birmingham, GBR.

|November 18, 2025

Summary

Post-reduction shoulder X-rays are often inadequate, with most cases missed by doctors. Improving imaging standards for anterior shoulder dislocation is crucial for patient safety and accurate diagnosis.

Keywords:

emergency medicine and trauma orthogonal views plain radiography quality improvement shoulder anterior dislocation

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Area of Science:

Orthopedic Surgery
Emergency Medicine
Radiology

Background:

Anterior shoulder dislocation is a frequent emergency presentation requiring post-reduction imaging.
Orthogonal views (anteroposterior and axillary/scapular Y) are recommended by guidelines to confirm reduction and detect injuries.
Inadequate imaging risks missed malreduction, fractures, and repeat procedures.

Purpose of the Study:

To evaluate compliance with post-reduction radiographic standards for anterior shoulder dislocation.
To assess the recognition and management of inadequate imaging by resident doctors.

Main Methods:

Retrospective service evaluation of 22 patients with anterior shoulder dislocation.
Definition of radiographic adequacy based on orthogonal post-reduction views per BESS and local guidelines.
Data collection on demographics, imaging adequacy, recognition of inadequacy, repeat imaging, and further investigations.

Main Results:

Only 22.7% of patients received adequate orthogonal post-reduction radiographs.
Inadequate imaging occurred in 77.3% of cases, with only 11.8% recognized by residents.
No repeat imaging was ordered in the emergency department for inadequate films.

Conclusions:

Poor compliance with post-reduction imaging standards for shoulder dislocation was observed.
Inadequate films were rarely recognized by resident doctors, indicating a guideline compliance and training issue.
Ensuring orthogonal views is a low-cost intervention to improve patient safety and diagnostic certainty; targeted education and re-audit are recommended.