Original contributionReduction of Anterior Shoulder Dislocations by Spaso Technique: Clinical Results
Introduction
Shoulder dislocation is the most common among the large joint dislocations, with 85% presenting as anterior dislocations (1). There are many different techniques described in the literature to reduce an anteriorly dislocated shoulder. Methods are mainly composed of traction, leverage, or a combination of both actions (2). The Spaso technique consists of gentle traction, external rotation, and minimal manipulation. This method was first described in 1998, but has not yet been well evaluated in the literature. It was reported to be simple, effective, and able to be performed by a single operator (3). The aim of this prospective study was to assess clinical efficacy of the Spaso technique and to evaluate its complications.
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Materials and Methods
Two training hospitals participated in this study. All shoulder dislocations that were referred to both hospitals between June 2005 and December 2005 were included in this study. Each hospital's patient group was restricted to 26 patients.
The Spaso technique was demonstrated to orthopedic residents in a classroom setting. They were asked to perform this method as their first choice in the treatment of acute anterior shoulder dislocations. Injuries classified as Neer's three- or four-part
Results
There were 42 male and 10 female patients. The average patient age was 33 years, with a range between 17 and 78 years. Most of the injuries were caused by a stress on the shoulder in abduction-external rotation (11 patients), after a simple fall (28 patients), or while playing contact sports (7 patients). The mechanism of injury was a fight in 3 patients; horse kick and epileptic seizure were the other reasons.
Twenty-four patients (46.2%) had primary dislocations. The average time between
Discussion
The Spaso technique is a combination of three main maneuvers: forward flexion, gentle traction, and external rotation (3). In other humeral abduction maneuvers, such as the Milch technique or the Eskimo technique, forward flexion has been reported as a component of these approaches (4, 5, 6, 7). Self reduction techniques and scapular manipulation maneuvers use forward flexion as well (7, 8, 9, 10, 11). In our opinion, forward elevation changes the direction of the conjoint tendon, long head of
Limitations
There were certain deficiencies in this series. First, this is not a randomized study to compare results with other techniques. Second, the study has a relatively limited patient group for statistical analysis. Finally, the entire investigation was completed with junior residents and it is not clear that similar success rates can be achieved in other settings.
Conclusions
In conclusion, the Spaso technique is a simple, rapid, and reliable technique for acute shoulder dislocation. It is a successful reduction maneuver and had no complications in this small series of patients. Even in inexperienced hands, the method could be performed sufficiently without anesthesia.
Acknowledgment
The authors thank Robert Reddix, md, Wake Forest University School of Medicine, Baptist Medical Center, Winston-Salem, North Carolina, for editorial review of this material.
References (18)
- et al.
Anterior shoulder dislocations: beyond traction-countertraction
J Emerg Med
(2004) Reduction of anterior shoulder dislocations by scapular manipulation
Ann Emerg Med
(1993)- et al.
External rotation method of shoulder dislocation reduction
JACEP
(1979) Best of both (BOB) maneuver for rapid reduction of anterior shoulder dislocation
J Emerg Med
(2005)- et al.
Glenohumeral instability
- et al.
Subluxations and dislocations about the glenohumeral joint
- et al.
An easy method to reduce anterior shoulder dislocation: the Spaso technique
Emerg Med J
(2001) - et al.
The Milch technique for reduction of anterior shoulder dislocations in accident and emergency department
Arch Emerg Med
(1992) - et al.
Reduction of acute anterior shoulder dislocations using the Milch technique: a study of ski injuries
J Trauma
(1981)
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