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

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.