Traction – Countertraction Techniques

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Traction – Countertraction Techniques

Sayegh FE, Kenanidis EI, Papavasiliou KA, Potoupnis ME, Kirkos JM, Kapetanos GA. Reduction of acute anterior dislocations: a prospective randomized study comparing a new technique with the Hippocratic and Kocher methods. J Bone Joint Surg Am. 2009 Dec; 91(12): 2775-82. [EXPAND Abstract]

Background: There are several methods to reduce anterior shoulder dislocations, but few studies have compared the efficacy, safety, and reliability of the different techniques. As a result, deciding which technique to use is seldom based on objective criteria. The aim of the present study was to introduce a new method to reduce an anterior shoulder dislocation, which we have termed “FARES” (Fast, Reliable, and Safe), and to compare it with the Hippocratic and Kocher methods in terms of efficacy, safety, and the intensity of pain felt by the patient during reduction. METHODS: Between September 2006 and June 2008, a total of 173 patients with an acute anterior shoulder dislocation (with or without a fracture of the greater tuberosity) were enrolled in the study. One hundred and fifty-four patients, who met all inclusion criteria, were randomly assigned to one of the three study groups (FARES, Hippocratic, and Kocher) and underwent reduction of the dislocation by first or second-year orthopaedic surgery residents. A visual analog scale was used to determine the intensity of the pain felt by the patient during reduction. RESULTS: Demographically, the groups were comparable in terms of age, male:female ratio, the mechanism of dislocation, and the mean time between the injury and the first attempt at reduction. Reduction was achieved with the FARES method in 88.7% of the patients, with the Hippocratic method in 72.5%, and with the Kocher method in 68%. This difference was significant, in favor of the FARES method (p = 0.033). The mean duration of the reduction maneuver was significantly shorter for the FARES method (2.36 +/- 1.24 minutes for the FARES method, 5.55 +/- 1.58 minutes for the Hippocratic method, and 4.32 +/- 2.12 minutes for the Kocher method; p < 0.001), and the mean visual analog pain score was significantly lower for the FARES method (1.57 +/- 1.43 for the FARES method, 4.88 +/- 2.17 for the Hippocratic method, and 5.44 +/- 1.92 for the Kocher method; p < 0.001). No complications were noted in any group. CONCLUSIONS: The FARES method is a significantly more effective, faster, and less painful method of reduction of an anterior shoulder dislocation in comparison with the Hippocratic and Kocher methods. It is easily performed by only one physician, it is applicable to anterior shoulder dislocations as well as simple fracture-dislocations, and its use is associated with no more morbidity than that associated with the other two methods.[/EXPAND]

Journal of Bone and Joint Surgery
Ceroni D, Sadri H, Leuenberger A. Anteroinferior shoulder dislocation: an auto-reduction method without analgesia. J Ortho Trauma 1997; 11(6): 399-404. [EXPAND Abstract]

When using the reduction method described by Boss-Holzach-Matter, the authors attained an overall success rate of 60 percent, with a mean reduction time of three minutes and a time interval varying from fifteen seconds to nine minutes. The Boss-Holzach-Matter method is a reduction technique for anteroinferior shoulder dislocations that can be used without premedication or anesthesia. The authors recommend it for those patients who are not going to be sedated and for whom “quick” reduction and early discharge is desirable.[/EXPAND]

Journal of Orthopaedic Trauma

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