DO ALL FIRST-TIME TRAUMATIC ANTERIOR SHOULDER DISLOCATIONS REQUIRE SURGERY? A RETROSPECTIVE COHORT STUDY

Abstract

The optimal management following first time traumatic anterior shoulder dislocation in young adults remains uncertain. This study is to evaluate whether surgical intervention should be considered following first time traumatic anterior shoulder dislocation, with focus on patients aged 25 years or younger. We retrospectively reviewed all patients presenting with a first-time shoulder dislocation to our unit between January 2022 and December 2023. Data were collected from clinical and radiological records. Patients were stratified into three age groups ≤25, 25–40, and >40 years. The primary outcome was re-dislocation following non-operative management with two years follow up. Total of 140 patients were included (mean age 52 years, range 14–95), with 65% male and 34% female. Nerve injuries occurred in 16% of patients, predominantly affecting the axillary nerve, and resolved spontaneously. Only two cases (1.5%) required urgent open reduction. Nineteen patients (14%) required surgical intervention: Rotator cuff repair 7, open laterjet 4, arthroscopic stabilisation 3, ORIF greater tuberosity 4, ORIF glenoid 1. Re-dislocation rates within two years varied by age, with the highest rate observed in patients aged ≤25 years (7/30, 23%), compared with 20% in those aged 25–40 years and 7% in patients over 40 years. The observed re-dislocation rate of 23% was substantially lower than the commonly cited 70% for this young age group and was more consistent with finding from recent studies. Indirect comparison with recent literature suggests a number needed to treat of six to prevent one re dislocation in high-risk younger patients. This supports early surgical intervention, although its cost effectiveness remains uncertain.