The Noergaard technique is a non-traumatic method for reduction of anterior shoulder dislocation.

INTRODUCTION: In this article, we describe the Noergaard technique for reduction of anterior shoulder dislocation. This is an atraumatic reduction method proven successful through several years of practice. We describe and evaluate the results of this technique through a retrospective analysis of patients admitted and treated for anterior shoulder dislocation at the emergency department (ED) of Hvidovre Hospital, Denmark, in a one-year period. METHODS: We reviewed the charts of all patients admitted with anterior shoulder dislocation (n = 151) at the ED. In the Noergaard technique, the patient is placed standing, bent over forwards in front of the rail on a hospital bed, resting the forehead on the back of the non-affected forearm, which is placed on the rail. The affected arm should now be relaxed and stretched, hanging straight down towards the floor. The patient is then instructed to relax as much as possible and make pendular and circular motions with the affected arm hanging down. RESULTS: Reduction was primarily attempted in 67 patients using the Noergaard technique. Successful reduction was achieved in a total of 52 patients (77%). CONCLUSIONS: The Noergaard technique seems to be a safe and atraumatic reduction technique that involves no physical manipulation of the affected limb. Based on our results and experience, we recommend the use of this technique as first line of treatment in anterior shoulder dislocations. FUNDING: none. TRIAL REGISTRATION: The study was registered with www.clinicaltrials.gov (NCT03649373).

Knee pain and associated complications after intramedullary nailing of tibial shaft fracture.

INTRODUCTION: The treatment of choice for unstable diaphyseal fractures in the tibia is reamed insertion of an intramedullary nail (IMN). The most common complication to this treatment is chronic knee pain with reported rates ranging from 10% to 87% with a mean of 47.4% in meta-analyses. METHODS: This study evaluates the long-term outcome after IMN insertion in adult patients with a tibial shaft fracture using the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. The study includes patients operated on one of five Danish hospitals in a five-year period. The patients received a KOOS questionnaire with questions regarding knee-specific symptoms, stiffness, pain, function and quality of life. Data were subsequently compared to those of a reference population. RESULTS: A total of 391 patients were enrolled from the trauma centre's database search. 55 patients did not meet the inclusion criteria. Questionnaires were sent out to 336 patients and 223 (66%) responded. Mean age was 47.9 years at the time of surgery; 63% were men. The follow-up time ranged from 1.7 to 6.7 years. CONCLUSIONS: With a follow-up time of more than six years after receiving an IMN, patients in this study experienced more knee-specific symptoms, pain, limitations in sports and daily living than a reference population who had not undergone surgery. The study population also reported poorer quality of life outcomes than the reference population. FUNDING: none. TRIAL REGISTRATION: Approved by the Danish Data Protection Agency. Clinical trials: NCT03649360.