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Closed reduction of shoulder dislocations in the emergency department

does an emergency medicine residency affect the orthopaedic resident experience?

Mondestin, Max MD; Barfield, William R. PhD; Griffith, Adam MD; Smalley, Jeremy MD; Woolf, Shane K. MD

doi: 10.1097/BCO.0000000000000564

Background: The shoulder is a mobile joint at risk for dislocation that can lead to presentation to an emergency department (ED). Our objective was to study the impact of establishing an emergency medicine (EM) residency program on the orthopaedic resident experience in management of simple shoulder dislocations (SSD).

Methods: A retrospective review of patients presenting to the ED with a diagnosis of an isolated SSD was conducted based on ICD-9/CPT code. The time intervals studied were: 2006-07 (Group 1, pre-EM residency) and 2012-13 (Group 2, post-EM residency). Forty-three patients met inclusion criteria in group 1; 38 patients met the inclusion criteria in group 2. Outcomes studied were reduction attempts and success rates by EM and orthopaedic residents.

Results: In Group 1, orthopaedic residents attempted reductions in 37% (16 of 43) of the patients and were 100% successful in the ED. There was a mean of 2.67 reduction attempts per orthopaedic junior resident per year. In group 2, orthopaedics attempted reductions in 29% of the patients (11 of 38). Orthopaedic residents were successful in nine of 11 of ED reductions. There was a mean of 1.57 attempts at shoulder reductions per orthopaedic resident per year. The average number of shoulder reduction attempts per orthopaedic resident was not significantly different between the groups (P=0.566).

Conclusions: No significant change in the number of reductions managed by either department was shown, but the discrepancy should be discussed. Orthopaedic residency directors should audit their trainees experience with SSDs and consider collaborating with the EM program to optimize training opportunities.

Department of Orthopaedics, Medical University of South Carolina, Charleston, SC

Financial Disclosure: Dr. Smalley discloses a financial relationship with Clinical Assessment Software outside this work. Dr. Woolf discloses a financial relationship with MTF Medical Board and Microaire outside this work. The other authors have no disclosures. The authors report no conflicts of interest.

Correspondence to William R. Barfield, PhD, Department of Orthopaedics, Medical University of South Carolina, Surgery, 96 Jonathan Lucas Street, Suite 708, Charleston, SC 29425 Tel: +843-792-3704; fax: +843-792-3843; e-mail:

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