Best Position and Duration for Immobilization in Primary Anterior Shoulder Dislocation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Volume 5 - Issue 1

Dharmesh Patel*, Avtar Singh, Rajeev Vohra and Sandeep Chauhan

• Senior Resident, MBBS, DNB (Ortho), University Amandeep Hospital, India

Received:February 05, 2021;   Published:February 23, 2021

Corresponding author: Dharmesh Patel, Senior Resident, MBBS, DNB (Ortho), University Amandeep Hospital, G T road, Model Town, Amritsar, Punjab, India

DOI: 10.32474/OSMOAJ.2021.05.000205

 

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Abstract

Background: Anterior shoulder dislocation is the most common injury of the glenohumeral joint and primarily caused by traumatic event and shoulder instability. Recurrent dislocation of anterior shoulder dislocation is a common occasion following the primary anterior shoulder dislocation. Generally, anterior shoulder dislocations are treated with closed reduction, stages of immobilization, and series of physical exercise treatment. This systematic and meta-analysis study were conducted to consider the best duration and position of immobilization after primary anterior shoulder dislocation reduction to reduce the risk of anterior shoulder dislocation recurrence.

Materials and Methods: PubMed, Cochrane, NCBI, Elsevier were used to searched randomized controlled trials. Two reviewers selected studies for inclusion, assessed methodological quality, and extracted data. The studies were peer-reviewed by two consultant, then selected based on inclusion criteria.

Study Design: Systematic review and meta-analysis; Level of evidence, I, II.

Result: A total of seven randomized controlled trials (635 patients) included in this systematic review and meta-analysis. In these studies, the recurrence rate of instability in ER group was 23.45% (76/324) versus IR group was 33.44% (104/311). Pooled data showed that ER immobilization significantly reduced the recurrence rate of instability (risk ratio, 1.83; P= 0.0001) compared to IR immobilization. Pooled data also summarized that immobilization in 3 weeks significantly reduced the risk of recurrence compared to ER immobilization in 4 weeks (risk ratio, 2.35; P=0.01). The subgroup analysis has been made and there was no significant difference between ER immobilization and IR immobilization in patient aged <30 years (P=0.29). Analysis on 3 studies showed that there was no significant difference in WOSI score between both groups (p=0.32).

Result:Best position and duration for primary anterior shoulder dislocation is ER immobilization in 3 weeks. This study found it significantly reduces the risk of recurrence instability. Furthermore, more studies needed to support the result of our studies to determine best assessment for anterior shoulder dislocation and the risk of recurrence instability.

Keywords: Anterior Shoulder Dislocation; Immobilization; External Rotation; Recurrence Rate; Meta-Analysis

Abstract| Introduction| Materials And Methods| Results| Description of Studies| Discussion| Conclusion| References|