Department of Emergency Care, Uludağ University Faculty of Medicine, Bursa-Turkey.
Department of Orthopaedics and Traumatology, Uludağ University Faculty of Medicine, Bursa-Turkey.
Ulus Travma Acil Cerrahi Derg. 2021 Jan;27(1):115-121. doi: 10.14744/tjtes.2020.29402.
Anterior shoulder dislocation is the most common shoulder injury in patients presenting to the emergency department (ED). Up to 25% of these injuries are fracture-dislocations. In general, the standard approach is to obtain plain radiographs before and after reduction. Fresno-Quebec Rules (FQR) are described to identify the patients who require an x-ray before reduction to reduce radiation exposure and delays in treatment. We aimed to evaluate the efficacy of clinical predictors used in the Fresno-Quebec algorithm for detecting a shoulder fracture-dislocation.
Records of patients who presented to the Emergency Department with presumed shoulder dislocation were retrieved and retrospectively analyzed according to 'Fresno-Quebec Rule (FQR)'. Sensitivity, specificity, and predictive values of FQR for detecting associated injuries were calculated.
Eighty-nine (65.9%) men and 46 (34.1%) women were included. The mean age of patients was 46 years (16-89). Ninety-nine (73.3%) of the cases had their shoulder dislocated for the first time, whereas 36 (26.7%) patients had a recurrent dislocation. Fifty percent of the patients (18 cases) with recurrent dislocation presented with an atraumatic episode. The remaining 18 patients with a history of recurrent dislocations had their shoulder dislocated as a result of trauma, and four (22%) of them had fracture-dislocation. Using the Fresno-Quebec rules yielded 100% specificity for the diagnosis of fracture-dislocation. The severity of the injury mechanism was not predictive in traumatic but recurrent dislocations. Only one of four patients with a fracture-dislocation in the traumatic recurrent dislocation group had high energy trauma.
FQR has 100% sensitivity in detecting fracture-dislocations in patients admitted to ED with anterior shoulder dislocation. It utilizes simple parameters that are easy to use and recall. Using these rules, 30% of unnecessary radiographs can be avoided, saving time and money and reducing radiation exposure in anterior dislocations.
前肩脱位是急诊科（ED）就诊患者最常见的肩部损伤。这些损伤中有 25%是骨折脱位。一般来说，标准方法是在复位前后拍摄普通 X 光片。Fresno-Quebec 规则（FQR）用于确定需要在复位前进行 X 光检查的患者，以减少辐射暴露和治疗延误。我们旨在评估 Fresno-Quebec 算法中用于检测肩骨折脱位的临床预测因子的功效。
根据“Fresno-Quebec 规则（FQR）”，检索并回顾性分析了因疑似肩脱位就诊于急诊科的患者记录。计算 FQR 检测相关损伤的敏感性、特异性和预测值。
共纳入 89 例男性（65.9%）和 46 例女性（34.1%）。患者的平均年龄为 46 岁（16-89 岁）。99 例（73.3%）患者首次肩部脱位，36 例（26.7%）患者为复发性脱位。50%（18 例）复发性脱位患者为无创伤性发作。其余 18 例有复发性脱位病史的患者因创伤导致肩部脱位，其中 4 例（22%）有骨折脱位。使用 Fresno-Quebec 规则对骨折脱位的诊断具有 100%的特异性。创伤性和复发性脱位中损伤机制的严重程度无预测性。在创伤性复发性脱位组的 4 例骨折脱位患者中，只有 1 例有高能量创伤。
FQR 对因前肩脱位就诊于 ED 的患者检测骨折脱位的敏感性为 100%。它利用了易于使用和回忆的简单参数。使用这些规则，可避免 30%的不必要的 X 光片，节省时间和金钱，并减少前脱位的辐射暴露。
