SHOULDER & ELBOW
Immobilization in external rotation after primary shoulder dislocation did not reduce the risk of recurrence: A randomized controlled trial.
This report has been verified
by one or more authors of the
original publication.
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2013;1(4):40 J Bone Joint Surg Am. 2011 May 18;93(10):897-904. Epub 2011 Apr 15.Exclusive Author Interview
Dr. Liavaag discusses shoulder immobilization following primary shoulder dislocation.
188 patients with primary traumatic anterior shoulder dislocation were randomized to be managed by immobilization in either internal rotation or 15° of external rotation for a period of 3 weeks. The 2-year follow up concludes that the re-dislocation rates were similar in both the treatment groups.
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)?
Sim = 1
Incerto = 0,5
Não relevante = 0
Não = 0
A Avaliação dos Critérios de Relato avalia a transparência com que os autores relatam as caraterísticas metodológicas e do ensaio na publicação. A avaliação está dividida em cinco categorias que são apresentadas de seguida.
4/4
Randomization
3/4
Outcome Measurements
4/4
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
O Índice de Fragilidade é uma ferramenta que auxilia na interpretação de achados significativos, fornecendo uma medida de força para um resultado. O Índice de Fragilidade representa o número de eventos consecutivos que precisam de ser adicionados a um resultado dicotómico para que o resultado deixe de ser significativo. Um número pequeno representa um resultado mais fraco e um número grande representa um resultado mais forte.
Porque é que este estudo era necessário agora?
There is a high risk of recurrence following a primary traumatic anterior shoulder dislocation, especially in the younger population. There have been several variable suggestions as to the best management. The orthopedic community is divided over the usefulness of the immobilization in external rotation. The study provides much needed evidence to determine best management.
Qual era a principal questão de investigação?
Does immobilization in external rotation provides any additional benefit to the future risk of recurrence, compared to standard immobilization in internal rotation?
Quais foram os resultados importantes?
- recurrence rate of 30.8% with immobilization in external rotation vs. 27.1% in internal rotation
- mean time to recurrence 10.5 months in External rotation group vs. 11.6 months in Internal Rotation group.
- median WOSI Score of 238 in external rotation vs. 375 in internal rotation group
De que é que me devo lembrar mais?
External rotation immobilizers are not beneficial to reduce the risk of future shoulder dislocation.
Como é que isto afectará o tratamento dos meus doentes?
Although this study finds that external rotation immobilizers are not beneficial, the sample size may be too small for definitive conclusions.
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