Acute complications associated with shoulder dislocation at an academic Emergency Department

Abstract

Shoulder dislocation is the most frequent dislocation treated in the Emergency Department (ED). Orthopedic literature cites up to a 55% incidence of fracture, vascular or neurologic injury associated with this injury, but these studies suffer from referral bias. No large ED series has been reported. This retrospective chart review was conducted in an academic ED for patients with shoulder dislocation presenting July 1, 1995-June 30, 2000. There were 263 charts identified; 73 were miscoded and 5 were lost, leaving 190 for analysis. Mean age was 34.3 years. Fifty-five patients had at least one fracture (29%), 48 of which (76%) were of the Hill-Sachs type. Despite presence of a fracture, all shoulders underwent successful ED reduction. Sensory nerve deficits were found in 24 (12.6%), which persisted after reduction in 25% of these patients. No vascular injuries were identified. The finding of fracture in 33% of patients with shoulder dislocation is in the range of rates reported in the orthopedic literature (15-55%). The finding that, despite the presence of a fracture, all underwent successful closed reduction is important, as one-third of these patients will have this condition. Neurologic deficits in 12% is significantly lower than the 21-65% reported in the orthopedic literature. Although complications associated with shoulder dislocation were relatively common, they did not significantly affect ED management.