Closed reduction techniques in acute anterior shoulder dislocation: modified Milch technique compared with traction-countertraction technique

Background: To perform closed manual reduction of acute anterior shoulder dislocation using the traction-countertraction technique requires sedation (TCTS) and the participation of 2 people. We studied the modified Milch (MM) technique, a positional reductive maneuver that requires 1 operator, without patient sedation or analgesia. Materials and methods: The study comprised 56 prospective nonrandomized consecutive patients, of whom 31 were in group A (MM, nonsedated) and 25 in group B (TCTS). Results: The success rate of MM technique was 83.9% (26 of 31), which increased to 96.3% (26 of 27) when 4 patients with associated greater tuberosity fractures were excluded. The success rate was 100% in the TCTS group, with 5 patients with associated greater tuberosity fractures. The reduction in pain from the preprocedural to intraprocedural phases in MM group was significant (P<.001), at a reduction rate of 2.07 (29%) on the numeric rating scale pain score. There was a greater pain reduction rate of 2.43 (34%) on the numeric rating scale when patients with greater tuberosity fractures were excluded. The MM group had a significantly shorter hospital stay (mean, 35 minutes) than the TCTS group (mean, 4 hours). No postreduction neurovascular or fracture complications occurred in either group. Conclusions: The results showed that the Milch technique was effective, safe, shortened hospital stay, and was well tolerated. We recommend the modified Milch technique as a first-line maneuver for acute anterior shoulder dislocations without associated fractures. Level of evidence: Level II, Prospective Cohort Study, Treatment Study. Crown Copyright (C) 2012 Published by Journal of Shoulder and Elbow Surgery Board of Trustees.