Case Report
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World J Orthop. Jan 18, 2014; 5(1): 57-61
Published online Jan 18, 2014. doi: 10.5312/wjo.v5.i1.57
Neurovascular complications due to the Hippocrates method for reducing anterior shoulder dislocations
Markus Regauer, Hans Polzer, Wolf Mutschler
Markus Regauer, Hans Polzer, Wolf Mutschler, Department of Trauma Surgery, Campus Innenstadt, Ludwig-Maximilians-University, 80336 Munich, Germany
Author contributions: Regauer M was the treating physician and was responsible for acquisition of data, writing the paper and design of illustrations and figures; Polzer H revised the article critically for important intellectual content and helped to design the illustrations and figures; Mutschler W was responsible for the final approval of the version to be published.
Correspondence to: Markus Regauer, MD, Department of Trauma Surgery, Campus Innenstadt, Ludwig-Maximilians-University, Nussbaumstrasse 20, 80336 Munich, Germany. markus.regauer@med.uni-muenchen.de
Telephone: +49-89-51602511 Fax: +49-89-51602662
Received: June 26, 2013
Revised: October 6, 2013
Accepted: November 1, 2013
Published online: January 18, 2014
Processing time: 208 Days and 2.7 Hours
Abstract

In spite of the fact that the Hippocrates method hardly has been evaluated in a scientific manner and numerous associated iatrogenic complications have been reported, this method remains to be one of the most common techniques for reducing anterior shoulder dislocations. We report the case of a 69-year-old farmer under coumarin anticoagulant therapy who sustained acute first time anterior dislocation of his dominant right shoulder. By using the Hippocrates method with the patient under general anaesthesia, the brachial vein was injured and an increasing hematoma subsequently caused brachial plexus paresis by pressure. After surgery for decompression and vascular suturing, symptoms declined rapidly, but brachial plexus paresis still was not fully reversible after 3 mo of follow-up. The hazardousness of using the Hippocrates method can be explained by traction on the outstretched arm with force of the operator’s body weight, direct trauma to the axillary region by the physician’s heel, and the topographic relations of neurovascular structures and the dislocated humeral head. As there is a variety of alternative reduction techniques which have been evaluated scientifically and proofed to be safe, we strongly caution against the use of the Hippocrates method as a first line technique for reducing anterior shoulder dislocations, especially in elder patients with fragile vessels or under anticoagulant therapy, and recommend the scapular manipulation technique or the Milch technique, for example, as a first choice.

Keywords: Anterior shoulder dislocation; Reduction technique; Hippocrates method; Complications; Brachial plexus paresis; Brachial vein injury; Scapular manipulation technique

Core tip: By using the Hippocrates method for reducing an anterior shoulder dislocation with the patient under general anaesthesia, the brachial vein was injured and an increasing hematoma subsequently caused brachial plexus paresis. The hazardousness of the Hippocrates method can be explained by traction on the outstretched arm with force of the operator′s body weight, direct trauma to the axillary region by the physician′s heel, and the topographic relations of neurovascular structures and the dislocated humeral head. Therefore we strongly caution against the use of the Hippocrates method as a first choice.