SHOULDER & ELBOW
Immobilization in External Rotation After Shoulder Dislocation Reduces the Risk of Recurrence: A Randomized Controlled Trial
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(11):232 J Bone Joint Surg Am. 2007 Oct;89(10):2124-31198 patients with an initial anterior shoulder dislocation were randomized to receive one of two immobilization treatments for a period of 3 weeks. One group had their arm immobilized in the conventional internal rotation position while the other group had their arm immobilized in the external rotation position. The primary outcomes examined were recurrence of dislocation or subluxation. Results indicated that external rotation immobilization at 10 degrees had a lower risk of recurrence compared to internal rotation immobilization. Patients under 30 years old also showed particularly more benefit.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
はい = 1
不確実＝0.5
無関係 = 0
いいえ = 0
報告基準評価では、著者が出版物内で試験の方法論的特徴や試験特性を報告する際の透明性を評価します。評価は以下の5つのカテゴリーに分類されます。
3/4
Randomization
3/4
Outcome Measurements
2/4
Inclusion / Exclusion
4/4
Therapy Description
4/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Fragility Indexは、重要な所見の解釈を助けるツールで、結果の強さの尺度を提供します。Fragility Indexは、その所見が有意でなくなるために、二項対立の結果に追加する必要がある連続した事象の数を表します。数値が小さいほど弱い所見を表し、数値が大きいほど強い所見を表します。
なぜ今この研究が必要なのですか？
The shoulder is one of the most common locations for dislocations and higher rates of recurrence seem to appear in younger patients. A high percentage of individuals with an initial anterior shoulder dislocation face recurrence of injury when the arm is immobilized in an internal rotation position. Cadaver studies and MRI imaging has shown that anterior shoulder dislocation (particularly the Bankart lesion) may heal better when immobilized in an external rotation position. This study examines the outcomes of shoulder immobilization in external rotation compared to internal rotation as part of anterior shoulder dislocation treatment.
主な研究課題は何ですか？
What are the risks of recurrence when external rotation immobilization of the shoulder is applied compared to internal rotation immobilization in the treatment of an initial anterior shoulder dislocation?
重要な知見は？
- The external rotation group had a recurrence rate of 26% (22/85) which was significantly lower than the internal rotation group which had a recurrence rate of 42% (31/74). (p=0.033)
- The external rotation group had a relative risk reduction of 38.2% and an absolute risk reduction of 16.0%.
- The group of patients under 30 years old had a relative risk reduction of 46.1%.
- The internal rotation group had a compliance rate of 53% (39/74) compared to the external rotation group which had a compliance rate of 72% (61/85). (p=0.013)
- 7% (6/85) patients had a minor complication of temporary stiffness that was resolved with self-directed range of motion exercises. No other complications were reported.
- The external rotation group had a significantly lower rate of recurrence when immobilization was started on the day of dislocation.
最も覚えておくべきことは？
Patients who had their arm immobilized in an external rotation (10 degrees) position for 3 weeks had a lower risk of recurrence compared to those who were immobilized in the internal rotation position. Patients under 30 years old appeared to have particularly more benefit from this treatment. The author also suggests that earlier mobilization may lead to better results.
それが私の患者ケアにどのように影響するか？
Patients undergoing an external rotation immobilization treatment for an initial anterior shoulder dislocation may have lower risks of recurrence compared to undergoing internal rotation immobilization - particularly in patients under 30 years old. Further studies are required to determine the optimal position and duration for external rotation immobilization.
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