BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSION: 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.
Keywords: Dangerous mechanism of injury; Fresno-Quebec; humerus fracture reduction; shoulder dislocation.