Acil servise öne omuz çýkýðý nedeniyle baþvuran hastalarda çýkýk ile birlikte kýrýk görülme risklerinin ve Fresno-Quebec Kurallarý’nýn geçerliliðinin geriye dönük deðerlendirilmesi

AMAÇ: Acil servise baþvuran hastalarda en sýk görülen omuz yaralanmasý anterior omuz çýkýðýdýr. Bu yaralanmalarýn %25’e kadarýnda eþlik eden kýrýk görülebilmektedir. Genel yaklaþým, redüksiyon öncesi ve sonrasýnda röntgen çekilmesidir. Radyasyon maruziyetini ve tedavide gecikmeleri en aza indirmek için, hangi hastalarýn redüksiyon öncesi radyografiye ihtiyaç duyacaðýný belirlemek üzere Fresno-Quebec Kurallarý (FQK) tanýmlanmýþtýr. Bu çalýþmada, Fresno-Quebec algoritmasýnda kullanýlan klinik belirteçlerin eþlik eden kýrýðý ortaya koymadaki etkinliðini incelemeyi amaçladýk.
GEREÇ VE YÖNTEM: Omuz çýkýðý þüphesi ile acil serviste deðerlendirilmiþ hastalarýn dosyalarý FQK’na göre geriye dönük olarak gözden geçirildi. FQK’nýn eþlik eden kýrýðý belirlemedeki duyarlýlýk, özgüllük, pozitif ve negatif öngörü deðerleri incelendi.
BULGULAR: Seksen dokuz (%65.9) erkek ve 46 (%34.1) kadýn hasta çalýþmaya alýndý. Hastalarýn ortalama yaþý 46 (16–89) idi. Doksan dokuz (%73.3) hasta ilk kez omuz çýkýðý geçirirken, 36 (%26.7) hastada tekrarlayan çýkýk mevcuttu. Tekrarlayan çýkýðý olan hastalarýn yarýsý (18 olgu) atravmatik çýkýktý. Kalan 18 hastada da tekrarlayan çýkýk öyküsü olmakla beraber son baþvurularýnda travmatik neden ve dört tanesinde de kýrýklý-çýkýk mevcuttu. FQK’nýn kýrýklý-çýkýklarý belirlemede %1000 duyarlýlýðý olduðu bulundu. Tekrarlayan fakat travma sonrasý geliþmiþ çýkýklarda yaralanma mekanizmasýnýn þiddetinin belirleyici olmadýðý görüldü. Tekrarlayan fakat travmaya baðlý çýkýðý olan hastalarýn dört tanesinde eþlik eden kýrýk mevcutken, bu dört olgunun sadece bir tanesi yüksek enerjili yaralanma sonucu meydana gelmiþti.
TARTIÞMA: FQK anterior omuz çýkýðý sebebi ile acil servise baþvuran hastalarda eþlik eden kýrýðý belirlemede %100 duyarlýlýða sahiptir. Kullanmasý ve hatýrlamasý kolay parametrelere dayanmaktadýr. Bu kurallarý kullanarak, gereksiz radyografileri %30 oranýnda azaltmak, maliyeti ve radyasyon maruziyetini düþürmek mümkündür.

Diagnostic accuracy of Fresno-Quebec Rules and risk factors for an associated fracture in patients presenting to the emergency department with anterior shoulder dislocation: A retrospective study

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.