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Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 102 - 102
1 May 2011
Malhotra A Freudmann M Hay S
Full Access

Aims: To discover how the management of traumatic anterior shoulder dislocation in the young patient (17–25) has changed, if at all, over the past six years.

Methods: The same postal questionnaire was used in 2003 and 2009, sent out to 164 members of British Elbow and Shoulder Society. Questions were asked about the initial reduction, investigation undertaken, timing of any surgery, preferred stabilization procedure, arthroscopic or open, detail of surgical technique, period of immobilization and rehabilitation programme instigated in first-time and recurrent traumatic dislocators.

Summary of Results: The response rate were 92% (n=151) – 2009, 83% (n=131) – 2003 The most likely management of a young traumatic shoulder dislocation in the UK would be:

Reduction under sedation in A& E by the A& E doctor (80% of respondents).

Apart from X-ray, no investigations are performed (80%).

Immobilisation for 3 weeks, followed by physiotherapy (82%).

68 % of respondents would consider stabilisation surgery for first time dislocators (especially professional sportsmen) compared to 35% in 2003.

Out of them nearly 90% would perform an arthroscopic stabilization vs. 57.5% in 2003. For recurrent dislocators:

75% would consider stabilisation after a second dislocation.

85% would investigate prior to surgery, choice of investigation being MR arthrogram (52%), compared to 50% in 2003 that would chose to investigate.

77% would choose to perform arthroscopic stabilisation compared to 18% in 2003, the commonest procedure being arthroscopic Bankart repair using biodegradable bone anchors (62% compared to 27% in 2003).

Following surgery, immobilisation would be for 3 weeks, full range of motion at 1 to 2 months and return to contact sports at 6 to 12 months.

Conclusions: There has been a remarkable change in practice compared to the previous survey. A significant proportion of Orthopaedic Surgeons would consider stabilisation in young first time dislocators instead of conservative management. Arthroscopic stabilisation is now the preferred technique compared to open stabilisation whenever possible. Surgeons are using more investigations prior to listing the patient for surgery namely the MR arthrogram. There is also an increased use of bio-degradable anchors as compared to metallic bone anchors in 2003.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 13 - 13
1 Jan 2011
Freudmann M Bollen S
Full Access

We aim to identify any changes in the demographics of ACL injured patients over the last decade. Over a twelve month period, the demographic data from 117 consecutive new patients with ACL injuries attending one consultant’s clinic in 1994 was prospectively recorded. This was then compared with data from a similar cohort of 103 consecutive new ACL injured patients attending the same clinic some twelve years later.

Since 1994, the proportion of women seen with ACL injury doubled from 12% to 25%. The proportion of skiing related injuries trebled from 9% to 28%. The average age at presentation rose by 6.5 years from 26.5 to 33. In 2006, the average age of the skiers was 40 and 72.4% of them were female compared to only 8% of non-skiers.

The population of patients with new ACL injuries has changed significantly over the last twelve years. The average age, proportion of women and number of skiing related injuries have all increased significantly. We speculate that the most likely cause of these changes is the skiing population, which has enlarged and, due to retention of participants, has aged over the period of this study (1). Most skiing injuries are sustained abroad and the vast majority of skiers buy holiday insurance to cover themselves against injury. Yet it is the NHS that ends up footing the bill for any reconstructive surgery and rehabilitation. We propose that if the insurance companies maintained responsibility for their clients’ injuries until a full recovery had been made, the NHS would save millions of pounds.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 418 - 418
1 Sep 2009
Freudmann M Bollen SR
Full Access

Aims: To identify any changes in the demographics of ACL injured patients over the last decade.

Methods: Over a twelve month period, the demographic data from 117 consecutive new patients with ACL injuries attending one consultant’s clinic in 1994 was prospectively recorded. This was then compared with data from a similar cohort of 103 consecutive new ACL injured patients attending the same clinic some twelve years later.

Results:

Since 1994, the proportion of women seen with ACL injury doubled from 12% to 25%

The proportion of skiing related injuries trebled from 9% to 28%

The average age at presentation rose by 6.5 years from 26.5 to 33

The average age of the skiers is 41 and 90% of them are female

Conclusion: The population of patients with new ACL injuries has changed significantly over the last twelve years. The average age, proportion of women and number of skiing related injuries have all increased significantly. We speculate that the most likely cause of these changes is the skiing population, which has enlarged and, due to retention of participants, has aged over the period of this study (1). Most skiing injuries are sustained abroad and the vast majority of skiers buy holiday insurance to cover themselves against injury. Yet it is the NHS that ends up footing the bill for any reconstructive surgery and rehabilitation. We propose that if the insurance companies maintained responsibility for their clients’ injuries until a full recovery had been made, the NHS would save millions of pounds.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 27 - 27
1 Mar 2008
Freudmann M Hay S
Full Access

A comprehensive postal questionnaire was sent to 164 orthopaedic consultants, all members of the Brit-ish Elbow and Shoulder Society. Questions were asked about the initial reduction, investigations undertaken, timing of any surgery, preferred stabilization procedure, arthroscopic or open, detail of surgical technique, period of immobilization and rehabilitation programmes instigated in first-time and recurrent traumatic dislocators. The response rate was 83% (n=136)

The most likely treatment of a young traumatic shoulder dislocation:

It will be reduced under sedation in A& E by the A& E doctor.

Apart from x-ray, no investigations will be performed

It will be immobilised for 3 weeks, then given course of physiotherapy

Upon their second dislocation, they will be listed directly for an open Bankart procedure (with capsular shift as indicated) during which subscapularis will be detached and metallic bone anchors used

Following surgery, they will be immobilised for 3 to 4 weeks, before being permitted full range of movement at 2 to 3 months and allowed to return to contact sports at 6 to 12 months

On the other hand, 54% of surgeons indicated they would investigate prior to surgery, 16% said their first choice operation would be arthroscopic stabilisation, the number of dislocations normally permitted before surgery ranged from 1 to more than 3, and the period of immobilisation post operation from nil to 6 weeks.

The results reveal a wide variation in practice and no clear consensus on how to best manage these patients. Open stabilisation remains the firm favourite. Does this mean arthroscopic stabilisation is regarded as an experimental procedure?


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_I | Pages 98 - 98
1 Jan 2004
Freudmann M Hay S
Full Access

To discover how traumatic anterior shoulder dislocation in the young patient (17–25) is managed by shoulder surgeons in the UK.

A comprehensive postal questionnaire was sent to 164 orthopaedic consultants, all members of BESS. Questions were asked about the initial reduction, investigations undertaken, timing of any surgery, preferred stabilization procedure, arthroscopic or open, detail of surgical technique, period of immobilization and rehabilitation programmes instigated in first-time and recur- rent traumatic dislocaters.

The response rate was 82% (n=135)

The most likely treatment of a young traumatic shoulder dislocation:

It will be reduced under sedation in A& E by the A& E doctor.

Apart from x-ray, no investigations will be performed

It will be immobilised for 3 weeks, then given course of physiotherapy

Upon their second dislocation, they will be listed directly for an open Bankart procedure (with capsular shift as indicated) during which subscapularis will be detached and metallic bone anchors used

Following surgery, they will be immobilised for 3 to 4 weeks, before being permitted full range of movement at 2 to 3 months and allowed to return to contact sports at 6 to 12 months

On the other hand, 54% of surgeons indicated they would investigate prior to surgery, 18% said their first choice operation would be arthroscopic stabilisation, the number of dislocations normally permitted before surgery ranged from 1 to more than 4, and the period of immobilisation post operation from nil to 6 weeks.

We now know how shoulder surgeons in the UK are treating this common injury. The results reveal that in Britain, we do not have a consistent approach, raising many discussion points. Open stabilisation remains the firm favourite. Does this mean arthroscopic stabilisation is regarded as an experimental procedure?