Patient and injury factors associated with failed closed reduction of anterior shoulder dislocation: A Systematic Review

Authors

  • Mazi Mohammed Alanazi Emergency Medicine Consultant, Head of Emergency Research Unit, Emergency Department, Riyadh First Health Cluster, Riyadh, Saudi Arabia. ORCID: 0009-0003-5836-8086. Author
  • Khalid Fares T. Al Otaibi Medical Intern, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia. Email: imkhaled.kh7@gmail.com. Author
  • Nibras Ahmed H. Medical Intern, College of Medicine, El Razi University, Khartoum, Sudan. Email: Nibrasahmed220@gmail.com. Author
  • Bassam Khalifah S. Alkhalifah Medical Intern, College of Medicine, Qassim University, Buraydah, Saudi Arabia. Email: Bassam112kh@gmail.com. Author
  • Sajjad Ibrahim A. Alhajji Medical Intern, College of Medicine, King Faisal University, Al Ahsa, Saudi Arabia. Email: sajjadibra45@gmail.com. Author
  • Saif Mohammed M. Alhurayji Medical Intern, College of Medicine, The Hashemite University, Zarqa, Jordan. Email: Saifalhurayjidr@gmail.com. Author
  • Asil Saqr M. Alenezi Medical Intern, College of Medicine, Northern Border University, Arar, Saudi Arabia. Email: aseelsaqr001@gmail.com. Author
  • Sulafah Ibrahim S. Alalawi Medical Intern, College of Medicine, Taibah University, Madinah, Saudi Arabia. Email: Sulafa1245@gmail.com. Author
  • Aryam Mohammed M. Baradah Medical Intern, College of Medicine, Sulaiman Alrajhi University, Qassim, Saudi Arabia. Email: aryambradh@gmail.com. Author

DOI:

https://doi.org/10.65759/xc778w97

Abstract

Anterior shoulder dislocation is managed routinely by closed reduction, while a minority of presentations remain difficult or fail emergency-department reduction. This systematic review analyzed patient and injury characteristics associated with unsuccessful reduction and separated procedural difficulty from structural causes of true irreducibility. A PRISMA 2020-aligned search framework covered PubMed, Scopus, Web of Science Core Collection, and the Cochrane Library from inception through August 2026, with citation chaining for studies. Eligible studies reported acute anterior dislocations and provided extractable information on reduction success, failure, repeated attempts, escalation to general anesthesia or surgery, or anatomical obstruction. Ten original studies were included, spanning prospective studies, randomized comparisons, retrospective emergency cohorts, and fracture-dislocation series. Delayed first reduction was the most consistent modifiable factor, with one adjusted study showing higher failure odds for each 10-minute delay from injury and from emergency-department arrival. Older age, falls, pain, displaced greater-tuberosity fracture, subglenoid position, surgical or anatomical neck fracture, and a humeral head locked beneath the glenoid were associated with difficulty in selected studies. Structural irreducibility arose from interposed biceps, labrum, rotator-cuff or subscapularis tissue, fracture fragments, and severe impaction. Evidence supports reduction of uncomplicated injuries and early recognition of adverse fracture or locking anatomy before repeated forceful manipulation. 

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Published

2026-08-29

Issue

Vol. 3 No. 3 (2026): Journal of Tazeez for Public Health

Section

Articles