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SA Orthopaedic Journal

On-line version ISSN 2309-8309
Print version ISSN 1681-150X

SA orthop. j. vol.8 n.4 Pretoria Jan. 2009




Shoulder dislocations: Management by doctors in emergency units



MJ MulderI; SJL RocheII; BC VrettosIII

IMBChB(UCT), FCS(SA) (Orth); Orthopaedic surgeon, Constantiaberg Medi-Clinic and Somerset Hospital
IIMBChB(UCT), FCS(SA) (Orth); Head Shoulder and Elbow unit, Department of Orthopaedics, University of Cape Town
IIIMBChB(Zim), FRCS(Eng), FCS(SA) (Orth), MMed(Orth) (UCT); Cape Town Centre for Bone and Joint Surgery, Vincent Palotti Hospital





The risk of recurrent instability after shoulder dislocation reduces with increasing age at time of first dislocation with recurrence in young patients of up to 100%. While traditional immobilisation has been shown to be ineffective, recent research suggests immobilisation in external rotation for three weeks reduces recurrence rates. We developed a questionnaire to determine how doctors working in emergency departments manage acute shoulder dislocations, to assess their knowledge and determine the source of their knowledge.
Doctors staffing the emergency departments of private and provincial hospitals, and registrars in emergency medicine, were surveyed regarding:
details of the doctor's rank, experience and training
number and details of dislocations managed and type and length of immobilisation
knowledge of prognosis for future dislocation
current and preferred sources of information.
Responses were subjected to multivariate analysis, allowing evaluation of the prevalence of misconceptions and identification of subsets of doctors who were better informed or who held similar beliefs.
Seventy questionnaires were completed (66.6%), with an average of 7.5 years post-graduate experience. All immobilised their patients for a period of between 1 and 6 weeks; however none did so in external rotation. Only 27% would refer patients for assessment by an orthopaedic surgeon. The redislocation rate for young patients was correctly chosen by 32.8%. Two-thirds of doctors incorrectly believed that redislocation is more common with increasing age. No group of doctors had statistically better knowledge than another. Books and colleagues were the most common, but were not the most preferred, sources of information.
We concluded that doctors working in emergency departments appear to have a poor understanding of existing and newer treatment options for shoulder instability and are not referring patients appropriately for orthopaedic specialist assessment. A variety of sources of knowledge are utilised, suggesting that multiple sources are required to better inform doctors of current and new treatment options.


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Dr MJ Mulder
Suite 209A
Constantiaberg Medi-Clinic
Burnham Road
7800 Plumstead
Tel: (021) 797-9141; Fax: (021) 797-9141



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