A comparison of the Milch and Kocher techniques for acute anterior dislocation of the shoulder

doi:10.1016/0020-1383(86)90161-0

Injury

Volume 17, Issue 5, September 1986, Pages 349-352

https://doi.org/10.1016/0020-1383(86)90161-0 Get rights and content

Abstract

Two methods of reduction for anterior dislocation of the shoulder were compared in 111 patients. Milch's technique was found to be atraumatic and relatively painless. Greater success with Milch's technique was experienced in patients under 40 years of age in whom the dislocation had been present for less than 4 hours. Milch's technique should be tried initially in patients fulfilling these criteria. In other cases Kocher's technique should be used first, especially in those of heavy build.

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There are more references available in the full text version of this article.

Cited by (75)

FARES Fared Better Than Others, But Is It Really One-Size-Fits-All?
2023, Annals of Emergency Medicine
A Systematic Review With Pairwise and Network Meta-analysis of Closed Reduction Methods for Anterior Shoulder Dislocation
2023, Annals of Emergency Medicine
To review closed reduction methods for anterior shoulder dislocation and perform the first comprehensive comparison of the individual methods in terms of success rate, pain, and reduction time.
We searched MEDLINE, PubMed, EMBASE, Cochrane, and ClinicalTrials.gov for randomized controlled trials registered until December 31, 2020. We performed a pairwise and network meta-analysis using a Bayesian random-effects model. Two authors independently performed screening and risk-of-bias assessment.
We found 14 studies with 1,189 patients. In a pairwise meta-analysis, no significant difference was found in the only comparable pair, namely, the Kocher method versus the Hippocratic method (success rate: odds ratio, 1.21; 95% confidence interval [CI], 0.53, 2.75: pain during reduction [visual analog scale]: standard mean difference, −0.33; 95% CI, −0.69, 0.02; reduction time [minutes]: mean difference, 0.19, 95% CI, −1.77, 2.15). In network meta-analysis, FARES (Fast, Reliable, and Safe) was the only method significantly less painful than the Kocher method (mean difference, −4.0; 95% credible interval, −7.6, −0.40). In the surface under the cumulative ranking (SUCRA) plot of success rate, FARES, and the Boss–Holzach–Matter/Davos method showed high values. For pain during reduction, FARES had the highest SUCRA value in the overall analysis. In the SUCRA plot of reduction time, modified external rotation and FARES had high values. The only complication was 1 case of fracture with the Kocher method.
Overall, Boss–Holzach–Matter/Davos, and FARES demonstrated the most favorable value for success rates, whereas both FARES and modified external rotation were more favorable in reduction times. FARES had the most favorable SUCRA for pain during reduction. Future work directly comparing techniques is needed to better understand the difference in reduction success and complications.
Comparison between new modified external rotation method and external rotation method for reduction of ASD
2020, American Journal of Emergency Medicine
Dislocation of the shoulder joint is common and is mainly anterior. Several reduction methods have been described and the external reduction method (ERM) is one of the newest. We modified the ERM by making some additions in hopes to develop a less painful, quick and simple method. The aim of this study was to compare the new modified external rotation reduction method (MERM) with ERM in acute anterior shoulder dislocations (ASD).
A total of 62 patients with ASD were classified randomly into 2 groups. The reduction was performed with MERM in one group and with ERM in the other group and the results were compared. Patients' pain scores, reduction time, success rate of the reduction methods, age, sex, dislocation side, dislocation time, previous dislocations history, injury mechanism, any complications, reduction time and neurovascular examination were collected. Parametric and nonparametric analyses were used to compare MERM and ERM.
The study cohort consisted of 62 patients (52 males, 10 females; mean age, 35 years; age range, 18–73 years) who were randomly assigned to treatment with the MERM (n = 32) or the ERM (n = 30). There was a statistically significant difference between the two methods in terms of time, and the MERM can be applied much faster than ERM (1.34 ± 1.41 min vs 3.05 ± 1.93 min; p < 0.001). The intra-reduction VAS pain score was not significantly in patients who were treated with MERM (85.31 ± 10.39 vs. 78.33 ± 16.54; p = 0.122).
MERM can be an alternate method compared to the ERM for the reduction of ASD.
Shoulder Dislocations in the Emergency Department: A Comprehensive Review of Reduction Techniques
2020, Journal of Emergency Medicine
Citation Excerpt :
However, many modern descriptions have included axial traction on the humerus as a component (23,82,84–86). This modified Kocher technique has been found to have a success rate of 72–97.5% (23,82,84–86). While most studies had no significant complications, 1 patient was found to develop a humeral neck fracture as a direct result of the traction-based Kocher technique (84).
Shoulder dislocations are a common presentation to the emergency department and one of the most frequent types of joint dislocations. Studies have found that delays from presentation to first reduction attempt and failed attempt at initial reduction are associated with lower rates of overall reduction success.
This article reviews 26 total reduction techniques, as well as a variety of modifications to these techniques. Each technique has distinct advantages and limitations associated with its use. While there are limited data comparing specific techniques, the individual success rates of most maneuvers range from 60–100%.
It is essential for emergency physicians to be familiar with multiple different reduction techniques in case the initial reduction attempt is unsuccessful or patient-specific characteristics limit the ability to perform certain techniques. This article reviews several reduction maneuvers for shoulder dislocations, variations on these techniques, and advantages and disadvantages for each approach. It is intended to serve as a resource for those interested in expanding their knowledge of shoulder reduction techniques.
The Emergent Evaluation and Treatment of Shoulder, Clavicle, and Humerus Injuries
2020, Emergency Medicine Clinics of North America
Reducing shoulder dislocation without anaesthesia or assistant: Validation of a new reduction manoeuvre
2019, Chinese Journal of Traumatology - English Edition
Shoulder dislocation comprises 60% of all major joint dislocations worldwide and a number of reduction techniques are described in the literature with varying degrees of success. The description of a large number of techniques speaks for itself that no method is effective all the times and one should be acquainted with more than one technique. An ideal method of reduction should be simple, easily reproducible, relatively painless that can be performed unassisted without sedation or anaesthesia with minimal or no further complications. We report our results of using a novel method of anterior shoulder reduction described recently in the literature that claims to fulfil most of the characteristics of an ideal method if not all.
This prospective study was conducted in a tertiary care centre. All the cases of primary anterior shoulder dislocation presenting within three days of injury without any associated fracture or spine trauma with or without greater tuberosity fracture were included. The reduction was done using a novel method by orthopaedic residents in all cases. The need for a second reduction attempt or anaesthesia was considered a treatment failure. Time taken for reduction, pain felt during reduction and complications if any were noted.
There were 47 (77.04%) males and 14 (22.95%) females with a mean age of (37.04 ± 12.63) years. The new technique was effective in locating a shoulder dislocation on the first attempt in 58 of the 61 dislocated shoulders (95.08%). The remaining three shoulders were reduced on second attempt by the same technique. Sedative, pre-medication or anaesthesia was not used in any case. The average time taken for the shoulder reduction was (130.5 ± 25.8) seconds and confidence interval (95%) 124–137 s. Iatrogenic complications were not seen in any of the patients.
This relatively painless technique of shoulder reduction is easy to acquire and practice in emergency department. The advantages of this manoeuvre and its associated safety may justly lead surgeons to select it as their primary method for reduction of anterior shoulder dislocations.

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A comparison of the Milch and Kocher techniques for acute anterior dislocation of the shoulder

Abstract

Surg. Clin. North Am.

Prognosis of primary dislocation of the shoulder

Acta Orthop. Scand.

Reduction of anterior dislocation of the shoulder by means of the Milch abduction technique

J. Bone Joint Surg.

A clinical trial of the ‘hanging arm’ reduction of dislocation of the shoulder

J. R. Coll. Surg. Edinb.