Consultation with an orthopedic surgeon should be obtained prior to reduction if the patient has a complicated shoulder injury, such as a Greater tuberosity fracture with > 1 cm displacement Significant Hill-Sachs deformity (≥ 20% humeral head deformity due to impaction against glenoid rim) Surgical neck fracture (below the greater and lesser tuberosities) Bankart fracture (anteroinferior glenoid rim) involving a bone fragment of over 20% and with glenohumeral instability Proximal humeral fracture of 2 or more parts Other reasons to consult with an orthopedic surgeon prior to reduction include The joint is exposed (ie, an open dislocation) The patient is a child, because a physeal (growth plate) fracture is often present The dislocation is older than 7 to 10 days, due to an increased risk of damaging the axillary artery during the reduction, especially in older patients Consultation with an orthopedic surgeon should be obtained after 2 or 3 failed attempts at closed reduction or after a successful reduction if A complicated shoulder injury is suspected (eg, dislocation plus fracture, axillary nerve injury, or rotator cuff tear) The patient has a first-time dislocation However, in all patients, if a neurovascular deficit is present, reduction must be done immediately.