Original contribution
Reduction of Anterior Shoulder Dislocations by Spaso Technique: Clinical Results

https://doi.org/10.1016/j.jemermed.2007.07.026Get rights and content

Abstract

The Spaso technique consists of forward flexion, external rotation, and gentle traction for the reduction of anterior shoulder dislocations with the patient in the supine position. The aim of this prospective study was to assess clinical efficacy of the Spaso technique and to evaluate its complications. We prospectively evaluated 52 shoulder dislocations using the Spaso technique. All reductions were performed by residents in training. Rescue methods if initial reduction was unsuccessful were at the discretion of the treating physician. Fifty-two patients were enrolled and 39 (75%) dislocations were successfully reduced without anesthesia or assistance. The mean reduction time was 3.2 min, and 87% of successful reductions occurred in less than 5 min. If we exclude the first 20 cases as a learning period, the success rate increases up to 87.5%. There were no complications associated with using the Spaso technique in this series. Patients with concomitant greater tuberosity fractures and late presentation had a lower success rate, although this was not statistically significant. The Spaso method is effective in reducing anterior shoulder dislocations without anesthesia or assistance and may decrease reduction time and length of stay in the Emergency Department.

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.

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