Disaster day: a simulation‑based competition for educating emergency medicine residents and medical students on disaster medicine

Disaster day: a simulation‑based competition for educating emergency medicine residents and medical students on disaster medicine

Anterior shoulder dislocation, Biomechanical reduction techniques, Length-of-stay, Emergency
department, Reduction rate, No medication

Background Biomechanical reduction techniques for shoulder dislocations have demonstrated high reduction
success rates with a limited pain experience for the patient. We postulated that the combination of biomechanical
reduction techniques with the shortest length of stay would also have the lowest pain experience and the highest
first reduction success rate.
Methods A randomized multicenter clinical trial was performed to compare different biomechanical reduction
techniques in treating anterior shoulder dislocations without the use of invasive pain relief. Patients who were able to

perform adduction of the arm were randomly assigned to Cunningham, the modified Milch, and the scapular manip-
ulation technique. Those who were not able to do so were randomly assigned to modified Milch and the scapular

manipulation technique. Primary outcomes were emergency department length of stay and pain experienced during

the reduction process, measured by the numeric pain rating scale. Secondary outcomes were reduction time, reduc-
tion success, use of analgesics or sedatives, and complications.

Results Three hundred eight patients were included, of whom 134 were in the adduction group. In both groups,

no differences in emergency department length of stay and experienced pain were observed between the treat-
ment arms. In the adduction group, the modified Milch technique had the highest first reduction success rates

52% (p=0.016), within protocol 61% (p=0.94), and with sedation in the ED 100% (−). In the no-adduction group,
the modified Milch was also the most successful primary reduction technique with 51% success (p=0.040), within
protocol 66% (p=0.90), and with sedation in the ED 98% (p=0.93). No complications were recorded in any of the
techniques.
Conclusion A combination of biomechanical techniques resulted in a similar length of stay in the emergency

department and showed similar pain scores with an overall high success rate of reduction. In both groups, the modi-
fied Milch had the highest first-reduction success rate.

Trial registration Netherlands Trial Register NTR5839—1 April 2016. Ethical committee Noord-Holland with the
CCMO-number NL54173.094.15

David N. Baden1*†, Martijn H. Roetman2†, Tom Boeije3

, Nieke Mullaart3

, Ralph Boden4

, Roderick M. Houwert5
,

Marilyn Heng6

, Rolf H. H. Groenwold7 and Olivier A. J. van der Meijden8

https://doi.org/10.1186/s12245-023-00480-6

2023

Peri Irawan

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