Shoulder dislocations attended in a regional hospital: Are all the radiographs ordered necessary?

Objectives: The aim of this study was to describe our hospital emergency departments

management of glenohumeral dislocations and to assess whether application of the

Quebec algorithm would significantly decrease the number of radiographs ordered.

Methods: Retrospective descriptive, cross-sectional study of cases treated in our regional

hospital emergency department in 2011. Among the variables analyzed were

sociodemographic characteristics, mechanism involved in causing the dislocation,

availability or not of a pre-reduction and/or post-reduction radiograph, and presence or

absence of fracture.

Results: A total of 89 glenohumeral dislocations were treated; 66.3% were in men. The

mean (SD) age was 45 years. Fracture was 6-fold more likely in patients over the age of

40 years than in younger patients. A pre-reduction radiograph was ordered in 87% of

the dislocations treated in our emergency department; a post-reduction radiograph was

ordered in 94.8% of these cases. Fractures were associated with the dislocation in 7

cases (8.1%). Fracture was significantly associated with the mechanism involved in

causing the dislocation (trauma vs nontrauma, P=.038). Nontrauma patients and those

with repeat dislocations did not have fractures. A total of 151 radiographs were ordered.

If the Quebec algorithm had been applied, approximately 75 radiographs would have

been ordered, leading to a savings of 49.6%.

Conclusions: Mechanism of injury and recurring dislocations are 2 of the factors related to

ordering a pre-reduction radiograph. Use of the Quebec decision-making algorithm would

have saved neerly half of radiographs.