Hovelius and colleagues followed young patients for 10 years after a first anterior shoulder dislocation to measure how often instability recurred and whether the kind and length of initial immobilization changed that.
Multicenter prospective study of 247 shoulders in 245 patients aged 12 to 40, from 27 Swedish hospitals.
Methods
Design
Multicenter prospective study
Data source
27 Swedish hospitals
Patients
245 patients with 247 primary anterior dislocations
Ages 12 to 40
Exposure
Arm bandaged to the torso for 3 to 4 weeks after reduction
Sling, stopped once comfortable
Immobilization of varying duration
Follow-up
10 years
Outcomes
Further dislocation
Recurrence treated operatively
Contralateral dislocation
Arthropathy on 10‑year radiographs
Key Findings
At 10 years, 129 shoulders (52%) had never redislocated, while 58 (23%) had developed recurrent instability treated with surgery.
A Hermodsson (Hill‑Sachs) lesion on initial films predicted redislocation (60 of 99 vs 38 of 86, p < 0.04) but not recurrent dislocation of 2 or more (51 vs 37, p = 0.31).
A greater tuberosity fracture at the first dislocation was linked to a significantly better 10‑year prognosis (p < 0.0002).
Of 107 shoulders with recurrent dislocation, 24 (22%) were classed as stabilized without surgery at 10 years.
In patients aged 12 to 22, contralateral dislocation rose from 6 of 102 shoulders (6%) at 2 years to 16 of 99 (16%) at 10 years.
Of the 208 shoulders radiographed at 10 years, 23 (11%) had mild and 18 (9%) moderate or severe arthropathy, and 6 of the 18 had never had recurrent dislocation.
Board pearl
Recurrence did not differ by initial treatment: 3 to 4 weeks with the arm bandaged to the torso did no better than a sling worn until comfortable.
Authors' conclusion
Although about one-third of the primary dislocations in our patients who were 29 years old or less needed operative treatment because of recurrence or remaining instability within 10 years, the results of the current study do not support a recommendation for routine prophylactic operative treatment, even for patients in the youngest age-groups.
Hovelius and colleagues followed young patients for 10 years after a first anterior shoulder dislocation to measure how often instability recurred and whether the kind and length of initial immobilization changed that.
Multicenter prospective study of 247 shoulders in 245 patients aged 12 to 40, from 27 Swedish hospitals.
Methods
Design
Multicenter prospective study
Data source
27 Swedish hospitals
Patients
245 patients with 247 primary anterior dislocations
Ages 12 to 40
Exposure
Arm bandaged to the torso for 3 to 4 weeks after reduction
Sling, stopped once comfortable
Immobilization of varying duration
Follow-up
10 years
Outcomes
Further dislocation
Recurrence treated operatively
Contralateral dislocation
Arthropathy on 10‑year radiographs
Key Findings
At 10 years, 129 shoulders (52%) had never redislocated, while 58 (23%) had developed recurrent instability treated with surgery.
A Hermodsson (Hill‑Sachs) lesion on initial films predicted redislocation (60 of 99 vs 38 of 86, p < 0.04) but not recurrent dislocation of 2 or more (51 vs 37, p = 0.31).
A greater tuberosity fracture at the first dislocation was linked to a significantly better 10‑year prognosis (p < 0.0002).
Of 107 shoulders with recurrent dislocation, 24 (22%) were classed as stabilized without surgery at 10 years.
In patients aged 12 to 22, contralateral dislocation rose from 6 of 102 shoulders (6%) at 2 years to 16 of 99 (16%) at 10 years.
Of the 208 shoulders radiographed at 10 years, 23 (11%) had mild and 18 (9%) moderate or severe arthropathy, and 6 of the 18 had never had recurrent dislocation.
Board pearl
Recurrence did not differ by initial treatment: 3 to 4 weeks with the arm bandaged to the torso did no better than a sling worn until comfortable.
Authors' conclusion
Although about one-third of the primary dislocations in our patients who were 29 years old or less needed operative treatment because of recurrence or remaining instability within 10 years, the results of the current study do not support a recommendation for routine prophylactic operative treatment, even for patients in the youngest age-groups.