What question did this study set out to answer?

To evaluate current emergency management practices for shoulder fracture-dislocation and propose a standard of care based on literature.

April 3, 2026Open Access

Emergency management of shoulder fracture-dislocation—An assessment of current practice in the Emergency Department of a University Teaching Hospital

Key Points

To evaluate current emergency management practices for shoulder fracture-dislocation and propose a standard of care based on literature.
Used mixed methodology with quantitative clinical audit and secondary analysis
Conducted qualitative interviews with clinicians
Evaluated a cohort of 39 patients presenting with shoulder fracture-dislocation
Assessed adherence to imaging protocols and management standards
67% of patients were female, and 79% were over 50 years old
41% followed the proposed imaging protocol for CT scans
92% met the management standard suggested for shoulder fracture-dislocation
Interviews emphasized the need for CT scans before reduction and the use of paralytic agents to minimize injury risk

Abstract

Isolated Greater Tuberosity (GT) fracture dislocations are routinely reduced in the emergency department, but there is risk of missing an occult neck of humerus fracture in certain patients, unless a CT scan is performed prior to reduction Shaw et al (BMC Musculoskelet Disord 20:482, 2019). There is also a known risk of iatrogenic harm when reducing a dislocated shoulder involving a fractured neck of humerus and this risk is increased without the use of an anaesthetic paralysing agent Yuan et al (JSES Int 5:56, 2025). 1: To propose an appropriate standard of care from the literature. 2: To compare a cohort of patients identified to the standard of care proposed. A mixed methodology study in a University Teaching Hospital. Quantitative research involving clinical audit and secondary analysis. Qualitative research involving in depth interviews with clinicians. A cohort of 39 patients who presented between 1st January 2024 and 10th March 2025 were identified. Twenty six patients (67%) were female and 31 patients (79%) were aged over 50. Sixteen patients (41%) met the imaging protocol proposed by Favian et al. (3), while 36 patients (92%) achieved the management standard proposed by Wronka et al.(4) In depth interview reiterated the need for CT prior to reduction and the importance of paralytic anaesthetic agents to reduce the risk of iatrogenic harm during certain reduction procedures. Patients aged over 50 or those with suspicion for occult neck of humerus fracture on plain film x-ray, should undergo CT prior to reduction. Fracture dislocations which are not isolated to the greater tuberosity should be referred to orthopaedics for consideration of reduction in theatre under general anaesthesia and a paralytic agent.

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