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Risk factors for the presence of important fractures in ED patients with shoulder dislocation: a retrospective cohort study
  1. Salomé Delattre Sousa1,
  2. Charles Henri Houze-Cerfon1,
  3. Thibault Le Gourrierec1,
  4. Sandrine Charpentier1,2,3,
  5. Xavier Dubucs1,2,3,
  6. Frederic Balen1,3
  1. 1Emergency Department, CHU Toulouse, Toulouse, France
  2. 2Faculté de médecine, Paul Sabatier University, Toulouse, France
  3. 3CERPOP, INSERM, Toulouse, France
  1. Correspondence to Dr Frederic Balen, Emergency, CHU Toulouse Pôle médecine d’urgences, Toulouse, France; fred.balen{at}gmail.com

Abstract

Background Prereduction shoulder X-rays are frequently done to rule out an important fracture that might preclude reduction of a shoulder dislocation in the ED. Our objective was to determine the risk factors for an important fracture in patients admitted to the ED with shoulder dislocation.

Methods This retrospective cohort study was conducted at the Toulouse University Hospital from 1 January 2017 to 31 December 2018. All patients admitted to the ED with clinical presentation of shoulder dislocation were included. The primary end point was the presence of an important fracture (excluding Bankart and Hill-Sachs fractures). Logistic regression was used to determine independent risk factors for the presence of an important fracture.

Results Six hundred and two patients were included in the study and 81 (13%) had an important fracture. Three risk factors were associated with important fracture: age over 40 years (adjusted OR (aOR)=2.7; 95% CI 1.5 to 4.8), first incident (aOR=4.3; 95% CI 1.7 to 10.8) and the circumstances in which the trauma occurred (fall from a height or direct impact, fall of over 1 m, road accident or epilepsy) (aOR=5.5; 95% CI 2.6 to 30). One hundred sixty-six patients (28%) had no risk factors in our cohort. In the absence of these risk factors, the risk of an important fracture was found to be 0.6% (95% CI 0 to 3.3).

Conclusion We describe 3 independent clinical risk factors associated with an important fracture in ED patients with shoulder dislocation: age >40 years, first incident and a traumatic circumstance. Prereduction radiography may be safely avoided when these factors are absent.

  • clinical assessment
  • emergency department

Data availability statement

Data are available on reasonable request. Data are available on reasonable request to the corresponding author.

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Data availability statement

Data are available on reasonable request. Data are available on reasonable request to the corresponding author.

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Footnotes

  • Handling editor David Metcalfe

  • Contributors SDS designed the work, performed acquisition and interpretation of data and drafted the manuscript. CHH-C helped for interpretation of data, revised the manuscript and approved this version to be published. TLG designed, revised the manuscript and approved this version to be published. SC helped for interpretation of data, revised the manuscript and approved this version to be published. XD helped for interpretation of data, revised the manuscript and approved this version to be published. FB performed statistical analysis and interpretation of data, drafted the manuscript and is the guarantor of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.