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Prediction of fracture associated with anterior shoulder dislocation.

Three Part Question

In [emergency department patients with anterior shoulder dislocation] which [historical factors predict] [shoulder fracture]?

Clinical Scenario

Your are an emergency medicine resident in a busy downtown tertiary care facility. Your 14th patient of the night is a 23-year-old male with a clinically obvious anterior shoulder dislocation. The dislocation was spontaneous and is his third this year. As a matter of routine a pre-reduction x-ray is ordered. ED beds are scarce and the the nurse asks if this is really necessary. Is it?

Search Strategy

Medline 1966-03/05 using the OVID interface, Cochrane Library (2005)
[(exp shoulder dislocation/ or anterior shoulder AND (*shoulder fractures/di, ra, ep). LIMIT to human AND English.

Search Outcome

37 papers found of which 36 were irrelevant or of insufficient quality.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses

Clinical Bottom Line

In selected patients, x-rays may be unnecessary in the management of anterior shoulder dislocation.


  1. Emond M. Le Sage N. Lavoie A. Rochette L. Clinical factors predicting fractures associated with an anterior shoulder dislocation. Academic Emergency Medicine. 11(8):853-8, 2004 Aug.