Травматический вывих плеча, нужен ли гипс?

[Sereda Andrey]

Чем дальше, тем меньше пользы у наружной ротации...
Immobilization with an External Rotation Brace Was Similar to an Internal Rotation Sling for Shoulder Dislocation
Clin Orthop Relat Res. 2014 Jan 3

Design:

Randomized (allocation concealed), blinded (outcome assessors, physical therapists, and data collectors), controlled trial with 2 years of follow-up.

Setting:

3 university centers in London, Ontario; Toronto, Ontario; and Calgary, Alberta, Canada.

Patients:

60 patients <35 years of age (mean age, 23 years; 92% men) who had a shoulder dislocation within the previous 7 days. Patients with a history of previous instability in the affected shoulder with associated fractures of the proximal part of the humerus, glenoid, or scapula were excluded. 50 patients (83%) were included in the analysis.

Intervention:

Patients were allocated to immobilization with an external rotation brace (n = 31) or an internal rotation sling (n = 29). The external rotation brace (DonJoy; DJO, Vista, California) positioned the injured upper arm in 90° of elbow flexion, 0° of shoulder abduction and flexion, and 0° to 5° of external rotation at the shoulder. The internal rotation sling (DonJoy; DJO) positioned the arm in 90° of elbow flexion, 0° of shoulder abduction and flexion, and 70° to 80° of internal rotation at the shoulder. After 4 weeks of immobilization, all patients began a 16-week physical-therapy program to resolve pain and swelling and restore range of motion, followed by strengthening exercises and functional rehabilitation.

Main outcome measures:

The primary outcome measure was recurrent instability (defined as a documented episode of anterior shoulder dislocation with radiographic evidence and/or requiring manipulative reduction) or multiple episodes of shoulder subluxation requiring surgical stabilization. Secondary outcome measures included quality of life assessed with use of the Western Ontario Shoulder Instability index (WOSI) (21 items, 100-point visual analog scale [VAS]) and the American Shoulder and Elbow Surgeons (ASES) evaluation form (11 items, 10-point VAS).

Main results:

Analysis was by intention to treat. The study had 80% power to detect a difference between event rates of 15% in the external rotation brace group and 55% in the internal rotation sling group. The brace and sling groups did not differ for rates of recurrent instability (37% vs. 40%, p = 0.82), recurrent dislocation (22% vs. 32%, p = 0.42), or recurrent instability requiring surgical stabilization (22% vs. 28%, p = 0.63). The mean overall WOSI score was 87% in the brace group and 84% in the sling group (p = 0.74). The ASES score slightly favored the brace group as compared with the sling group, with borderline significance (95 vs. 89 points, p = 0.05).

Conclusion:

In patients with a shoulder dislocation, immobilization with use of an external rotation brace did not reduce the rate of recurrent instability or improve quality of life more than use of an internal rotation sling.

[Sereda Andrey]

Буду со скуки эту тему еще лет 7 мониторить.

А необходимая продолжительность иммобилизации, кстати, - неделя.

Position and Duration of Immobilization After Primary Anterior Shoulder Dislocation
A Systematic Review and Meta-Analysis of the Literature
William H. Paterson, MD; Thomas W. Throckmorton, MD; Michael Koester, MD; Frederick M. Azar, MD; John E. Kuhn, MD
J Bone Joint Surg Am, 2010 Dec 15;92(18):2924-2933.

Analysis of the best available evidence indicates there is no benefit of conventional sling immobilization for longer than one week for the treatment of primary anterior shoulder dislocation in younger patients.

[Maxim_A]

С наружной ротацией, более менее понятно. IGHL все равно не натягивается без абдукции и вверх не подтягивается.
А вот по срокам иммобилизации.... интересно.... возникает вопрос: нужна ли она вообще?...