A while back I learned about the FARES method for reduction of anterior shoulder dislocations from the guys from Vanderbilt. Missing out the ‘do one‘ step of the classic trifecta of medical learning, I encouraged a colleague to use the FARES technique to reduce a child’s dislocated shoulder.
The reduction went so well that that the child’s mother asked if we would write down how to perform the procedure in the patient’s notes in case of a re-dislocation…
The FARES method is similar to the Milch technique
- While holding the patient’s wrist, apply traction to the affected limb in a neutral position beside the supine patient (can also be performed in the prone position).
- Move the limb anteriorly and posteriorly in small oscillating movements while continuing to apply traction and start slowly abducting the limb.
- Once the limb is abducted to 90 degrees, externally rotate the limb at the shoulder, with ongoing traction and oscillating anterior/ posterior movements. Continue to slowly abduct the limb past this position.
- Clunk! Reduction is usually achieved once the limb is abducted to 120 degrees.
I’m not a zealot of any particular shoulder reduction reduction technique (I like them all… it would be boring to do it the same way every time) but based on this n=1 trial, the FARES method is a string well worth adding to your bow. We performed the procedure with nitrous oxide and ‘Sponge Bob Square Pants’ on TV.
- Sayegh FE, Kenanidis EI, Papavasiliou KA, Potoupnis ME, Kirkos JM, Kapetanos GA. Reduction of acute anterior dislocations: a prospective randomized study comparing a new technique with the Hippocratic and Kocher methods. J Bone Joint Surg Am. 2009 Dec;91(12):2775-82
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.