Surgery—not sling—better for first-time shoulder dislocation

Primary repair versus conservative treatment of first-time traumatic anterior dislocation of the shoulder: A randomized study with 10-year follow-up. Arthroscopy 2007; 23:118-123.

* Clinical question

Should patients near a first-time anterior shoulder dislocation and injuries to the capsule or labrum receive surgical repair or conservative dream therapy?

* Bottom line

Primary open surgical repair for patients ages 15 to 39 who have a first-time traumatic anterior shoulder dislocation resulted in not as much of subsequent dislocations, less instability, and better patient self-satisfaction. This is a major renovate from current standard of care (conservative psychiatric help for first dislocations and surgery for recurrent dislocations only).

Level of evidence

1b: individual RCT (with decrease confidence interval)

Study design

Randomized controlled trial (nonblinded)

Funding

Unknown/not stated

Allocation

Uncertain

Setting

Emergency department

Synopsis

Appropriate treatment of first-time anterior shoulder dislocation remains controversial. Most patients receive conservative therapy, near surgical repair reserved for subsequent dislocations. These investigators enrolled 80 consecutive patients presenting to the emergency department beside traumatic anterior shoulder dislocation. Patients were 15 to 39 years of age and have no history of shoulder injury. After initial reduction, patients undergo arthroscopy within 1 week. A total of 76 patients (93.5%) beside confirmed capsular or labral injury randomly received (allocation concealment uncertain) any open surgical repair or conservative psychiatric therapy (immobilization in a fixed sling for 2 days, followed by a nonfixed sling for 1 week). Both groups received similar rehabilitation.

Complete follow-up occur for 98% of patients for 10 years. Blinding of outcome assessors to group assignment is uncertain, but primary outcomes (recurrent dislocation and long-suffering satisfaction) were unlikely to be artificial. Using intention-to-treat analysis, recurrent dislocation inside 10 years was significantly smaller amount likely near surgical repair than conservative treatment (9% vs 62%; number needed to treat=2; 95% confidence interval, 1-3).

Overall, 72% of those in the surgical group reported good or excellent results, while 74% surrounded by the control group reported unsatisfactory results. No significant complications were see in the surgical group. It remains to be see whether primary surgical repair will result in similar benefit contained by populations at higher risk of surgical complications, such as elderly and unoccupied patients with a lower rate of redislocation.

FAST TRACK

Surgically treated patients have fewer subsequent dislocations