Eine neue Repositionstechnik für die verhakte hintere Schulterluxation

The case of a 61-year-old male with posterior dislocation of the right shoulder joint is presented and a new technique for closed reduction of posterior locked shoulder dislocation is described. The technique involves four steps: in step 1 a constant traction is applied on the injured arm, in step 2 the arm is internally rotated and in steps 3 and 4 the second arm of the physician is used as a lever arm to lateralize and ventralize the shoulder. Lateralization and ventralization of the humeral head are essential to engage the humeral head and to pass it around the glenoid during reduction. Steps 3 and 4 are performed simultaneously. In the presented case the patient suffered a traumatic shoulder dislocation with a rim fracture of the glenoid. After reduction the shoulder was stable and conservative treatment was performed. A 2 year follow-up examination revealed a pain-free and stable shoulder with free range of motion and an Oxford instability score of 48 points. The described reduction technique for posterior locked shoulder dislocation is a simple and gentle technique, which can be performed easily by one person.Presentation of a reduction technique for locked posterior shoulder dislocation. Constant traction and internal rotation is performed for engaging the locked humeral head. After disengaging the humeral head the reduction is performed by using the arm of the physician as a lever arm.     

Systematic Review and Meta-Analysis of Locked Posterior Dislocation of the Shoulder Treated with Shoulder Arthroplasty: Improved Outcomes for Total Shoulder Arthroplasty are Associated with Increased Age

Locked shoulder dislocations account for up to 5% of shoulder dislocations. These relatively rare injuries are characterized by dislocation of the humeral head from the scapular glenoid cavity with the humeral head incarcerated on the glenoid in a “locked” fashion. Diagnosis is often delayed because of the complexity of clinical presentation and subtle radiographic findings, resulting in locking of the humeral head out of the glenoid cavity with severe functional deficits. Most commonly, there are bony injuries to the glenoid and humeral head that engage and prevent closed reduction. Since few patients present with this injury, evidence-based treatment guidelines have not been established. The objective of this review is to assess postoperative outcomes following shoulder arthroplasty for locked posterior shoulder dislocations (LPSD) to guide best practices for treatment. This systematic review was conducted following PRISMA guidelines, searching the PubMed and Web of Science databases for original articles assessing outcomes following arthroplasty for locked posterior shoulder dislocations. Seven publications that evaluated 102 patients were included. Additionally, nine case studies were included, assessing 20 shoulder arthroplasties. Overall, the analysis demonstrated significant improvement in shoulder pain following total shoulder arthroplasty (TSA) (P = 0.0003). Older operative patient ages for TSA resulted in significantly improved modified Neer outcomes scores and patient satisfaction compared to younger patients (P = 0.047). A positive correlation was noted for the duration of dislocation and necessity for revision surgery following hemiarthroplasty (HSA) and TSA combined and TSA separately. The risk ratios assessing the incidence of postoperative complications (RR = 0.56, 95% CI = 0.28–1.11) and necessity for revision surgery (RR = 0.58, 95% CI = 0.24–1.39) were insignificant but noted outcomes favoring TSA. Data from the included studies show that both TSA and HSA are efficacious at treating locked posterior shoulder dislocation. Postoperative outcomes following TSA versus HSA are similar. TSA may be a more efficacious surgical treatment in elderly patients, with improved outcomes and patient satisfaction scores compared to younger patients. Early diagnosis and treatment of posterior locked dislocations may lead to reduced postoperative complications and revision surgery, signaling the importance of proper injury investigation and early treatment. The role of RSA in the management of locked posterior shoulder dislocation remains to be determined, as there is insufficient clinical outcome data currently in the literature.     

Asymptomatic chronic anterior posttraumatic dislocation in a young male patient.

We report an unusual case of chronic anterior glenohumeral dislocation in a young active patient. The diagnosis was not made until 4 years after the initial injury occurred. X-ray evaluation and magnetic resonance imaging showed an anterior dislocated humeral head that was locked anteroinferior of the glenoid as a result of a large Hill-Sachs lesion. Passive and active range of motion was surprisingly normal, and the patient had no pain and no limitation in his activities of daily living. A chronic dislocation of the glenohumeral articulation has been defined as a joint that has been dislocated for at least several days. It is generally accepted that the longer the dislocation persists, the more the difficulties and complications of reduction increase. In most of the patients the persistence of an unreduced chronic dislocation is a very difficult problem. This condition is mostly seen in elderly patients and in those with limited general mental status. We report a case of a young male patient with only minor clinical symptoms.     

Arthroscopic Reduction and Repair of a Locked Posterior Shoulder Dislocation

Locked posterior shoulder dislocations are an uncommon but difficult problem for the orthopaedic clinician. Furthermore, they are often missed on initial presentation, resulting in significant delays in treatment. Traditional treatment has involved formal open reduction, most commonly from an anterior approach, followed by transfer of the lesser tuberosity or subscapularis tendon into the anterior humeral head defect. We present the case of a patient with locked posterior shoulder dislocation, who was treated with arthroscopically assisted reduction followed by arthroscopic posterior stabilization. Use of this technique allows the surgeon to reduce the dislocation without performing an open arthrotomy, thereby decreasing the patient’s overall morbidity. Furthermore, an arthroscopic technique used for stabilization allows visualization of the entire glenohumeral joint and enables the surgeon to directly address posterior disease, rather than compensating for the defect with an anteriorly based transfer.     

Anatomical reconstruction for Reverse Hill-Sachs lesions after posterior locked shoulder dislocation fracture: a case series of six patients

Introduction Posterior locked shoulder dislocation fracture is a rare injury. Impression fractures of the humeral articular surface are common with this injury. Different methods exist to restore impression fractures. We present a case series and the results of six patients that had an anatomical repair with spongiotic autograft/allograft for humeral head impression fractures after locked posterior shoulder dislocation. Material and methods Six patients with an average age of 52.5 years at time of surgery were included. All patients had an anteromedial impression fracture, one patient had an additional two part fracture. The injury was caused by epileptic seizures in five and by direct trauma in one patient. The diagnosis was made on the day of the injury for two patients (33%). For the other patients the time span between the injury and the diagnosis ranged between 5 and 180 days. The impressed cartilage of the defect was first elevated in one piece, the defect filled with the graft and the cartilage fixed on top of the graft by Mitek ancres introduced under the affected area. One patient had an additional two-part fracture that was fixed separately. Results At a mean time follow-up of 62.7 (18–95) months the result was found to be excellent for two patients and good for four patients with a mean Constant Score of 88.2 points (range 83–98). One patient had a redislocation after three months that was fixed by the same method. At the last follow-up no redislocation or graft collapse was seen. Conclusion The proposed method of anatomical head reconstruction by spongiotic auto/allograft proved to be a valid and good method to restore shoulder function and stability.     

Die dorsal verhakte Schulterluxation

Posterior dislocation of the shoulder is a rare injury and is often misdiagnosed at initial presentation. Shoulder function improves over the course of time with the joint still in locked dislocation. Misdiagnosis is due to a lack of clear clinical signs compared to anterior dislocation; thus, appropriate x-rays (i.e., true anterior-posterior and axial views) are indispensible. However, posterior dislocation frequently becomes chronic and closed reduction is not successful any more. In contrast to anterior dislocations, the humeral head defect accounts for recurrent instability. Depending on the size of the defect and the duration of the dislocation, there are different treatment options, including elevation of the defect, bone grafting, McLaughlin procedure, rotation osteotomy, and arthroplasty. The patient’s outcome strongly depends on the size of the humeral head defect and the interval between trauma and definite diagnosis. The smaller the defect and the quicker the diagnosis is made, the better the results. Recurrent dislocations rarely occur in comparison to traumatic anterior instability.     

陈旧性交锁肩关节后脱位手术治疗

目的 评价肱骨关节面复位加大块植骨治疗陈旧性交锁肩关节后脱位的疗效及结果.方法 2002年3月-2008年4月,对18例陈旧性交锁肩关节后脱位的患者,采用肱骨关节面复位加大块植骨进行手术治疗.全部患者受伤至接受手术时间平均为5个月,术前CT检查证实为陈旧性交锁肩关节后脱位,其中8例肱骨头前缘缺损(反Hill～Sachs征)在20%～25%之间,10例在25%～45%之间.结果 术后随访1～4年,平均2.6年.肩关节功能采用Constant评分:优7例,良9例,中1例,差1例;优良率为88.8%.1例患者术后肩关节僵直,但未有复发脱位.UCLA评分最高35分,最低13分,平均30分.结论 采用肱骨关节面复位加大块植骨治疗创伤导致陈旧性交锁肩关节后脱位,疗效肯定,肩关节功能恢复良好.     

Proximal humerus Salter type III physeal injury with posterior dislocation

Salter type 3 fractures of the proximal humerus are rare injuries. We report the first case of a Salter type 3 physeal fracture with posterior dislocation of the proximal humerus in a 16-year-old boy. The fracture pattern could not be evaluated by simple radiography, but was possible with the aid of MRI. The dislocated humeral head was locked behind the glenoid labrum. Open reduction was mandatory. Sixteen months after the operation, avascular necrosis of the humeral head was detected by simple radiography and MRI. Even though the patient had a full range of motion of the shoulder and no pain, a long-term follow-up is believed necessary.     

Locked inferior fracture dislocation after total hip arthroplasty

Acetabular fracture in conjunction with dislocation after total hip arthroplasty is a rarely reported event. We describe such a case with a unique fracture dislocation pattern, whereby the prosthetic femoral component dislocated inferiorly, fracturing the pelvis, and was locked in this position. The patient was treated with closed reduction under anesthesia and the fracture healed without further surgical intervention. However, she has experienced subsequent instability episodes and we have recommended revision surgery.     

Bilateral luxatio erecta complicated by venous thrombosis

Inferior shoulder dislocation or luxatio erecta is an exceedingly rare form of shoulder dislocation and compromises less than 0.5% of all shoulder dislocations. Furthermore, bilateral luxatio erecta is reported only nine times in the English literature. This paper documents the tenth case of bilateral luxatio erecta. This tenth patient suffered an axial load injury to his outstretched arms and displaced both humeral heads inferiorly. After closed reduction, the patient was discharged home on hospital day two. However, he developed an axillary vein thrombosis 3 days later and required anticoagulation therapy. This report reviews the mechanisms of injury associated with inferior shoulder dislocations as well as the presentation and treatment of luxatio erecta. The complication of axillary vein thrombosis and its treatment in this patient are discussed also.     

Locked posterior shoulder dislocation treated by arthroscopic tenodesis of the subscapularis in the reversed Hill-Sachs lesion

Report of a case of locked posterior shoulder dislocation, diagnosed after 3 weeks with an impression fracture involving almost 30% of the humeral head. Closed reduction was not stable. Shoulder arthroscopy confirmed the fracture and the unstable character of the dislocation. The subscapularis tendon was attached in this lesion using two suture anchors. Immediate shoulder stability was obtained. The 6-month follow-up was good, and the shoulder became stable and pain free. Arthroscopic tenodesis of the subscapularis may be an alternative to the McLaughlin technique in locked posterior shoulder dislocations involving 20–40% of the humeral head in cases presenting within 6 months after the initial episode.     

Aseptic Osteonecrosis of the Humeral Head After Anterior Shoulder Dislocation

Anterior shoulder dislocation is a very common trauma and the main complications are well documented. We report a case of aseptic osteonecrosis of the humeral head following an isolated episode of anterior glenohumeral dislocation without fracture that, to our knowledge, has never been reported in the literature. A 17-year-old male patient sustained an anterior gleno-humeral dislocation following a sport accident. It was managed by reduction and immobilization. A radiologically identified aseptic osteonecrosis appeared 6 months later. The instability had been arthroscopically treated. At a follow-up of 4 years, the osteonecrosis has been stabilized leaving a mild arthrosis with stiffness, but without pain.     

Humeral shaft fracture with ipsilateral shoulder dislocation

Although fracture of the humeral shaft or dislocation of the shoulder joint is a common injury, a simutaneous injury is rare. We present such a case com- bined with head injury which took precedence over the skel- etal injuries. The postoperative rehabilitation was slowed down by the head injury. This case report makes us aware of some problems when managing the patient with this rareinjury and helps us understand the management options better. Also the need for proper follow-up and rehabilitation is emphasized.     

Traumatic spondylolisthesis of L5-S1

Pure traumatic bilateral lumbosacral dislocation is a rare injury with just eight cases reported in the literature. This condition occurred also in 36-year-old man, who was struck into the lower back by a falling tree, during a woodcutting, at the moment when he was kneeling and his spine was flexed. Neurological examination showed no signs of spinal nerves injury. X-ray examination of the lumbosacral spine revealed the presence of a 40% anterior dislocation of L5 over S1 with locked facets and multiple fractures of transverse processes. Computer tomography confirmed these findings and also revealed massive medial L5-S1 disc herniation. Surgery performed 9 days after the injury consisted of L5 laminectomy, L5-S1 discectomy and segmental reduction and stabilization with transpedicular screws. Posterior lumbar interbody fusion was carried out using titanium PLIF-blocks. The patient healed without complications. At a 24-month follow-up he was without any subjective complaints, neurologically asymptomatic and without restriction of mobility in the lumbosacral spine. He was able to resume his previous work. This rare case is discussed in a view of the relevant literature, biomechanics of trauma and the appropriate therapy with an emphasis on open reduction and internal fixation techniques.     

Bilateral traumatic dislocation of the distal radioulnar joint, ulna dorsal: case report and review of the literature

Bilateral dislocation of the distal radioulnar joint seems not to have been reported in the literature. This is a report of a 22-year-old man successfully treated with closed reduction and immobilization in long arm casts. Limited forearm rotation and wrist pain after a twisting injury are typical findings. In ulna dorsal dislocation the patient's forearm is locked in pronation. In ulna volar dislocation the wrist appears narrow and the forearm is locked in supination. The mechanism of injury for dorsal dislocations is hyperpronation; for volar dislocations it is hypersupination. Dislocation of the distal radioulnar joint injures the triangular disk and/or fractures the ulnar styloid. Suspicion is important in making the diagnosis. Fifty per cent of unilateral cases reported in the literature were missed initially or were diagnosed late. The acute case is easily treated by closed reduction under local anesthesia and immobilization in a long arm cast. Treatment of the chronic dislocation includes various soft tissue reconstructions or resection of the distal ulna depending on the degree of arthrosis.     

Posterior dislocation of the shoulder associated with fracture of the humeral anatomical neck with 11-year follow-up after early open reduction and internal fixation

BACKGROUND:. The combination of posterior dislocation and fracture of the anatomical neck represents an extremely rare injury. METHODS:. A patient with posterior dislocation of the shoulder and ipsilateral fracture of the humeral anatomical neck was treated with open reduction and internal fixation with two Kirschner wires. He was followed up for 11 years. RESULTS:. The functional results were excellent, and X-ray and MRI investigations revealed the absence of avascular necrosis of the humeral head. CONCLUSION:. Early and accurate open reduction with minimal osteosynthesis resulted in excellent function of the injured shoulder without avascular necrosis.     

Bilateral posterior fracture-dislocation of the shoulder caused by an epileptic seizure – Diagnostic, treatment and result

The case of an 39-year-old man is presented, who sustained a bilateral locked fracture dislocation of the shoulders occurring during an epileptic seizure. Radiographs demonstrated a compression-fracture of the anteromedial aspect of the humeral head bilaterally (reversed Hill-Sachs-lesions). Additionally, fractures of the lesser and greater tuberosity were diagnosed at the right site. Open reduction and internal fixation was performed in both shoulders within 12 hours. 6 months later the patient has no complaints with a free range of motion. Diagnostics, treatment and result are discussed in context with the literature.     

Bilateral posterior fracture-dislocation of the shoulder caused by an epileptic seizure – Diagnostic, treatment and result Diagnostik, Behandlungsstrategie und Ergebnis bei einem Patienten nach epileptischem Anfall

The case of an 39-year-old man is presented, who sustained a bilateral locked fracture dislocation of the shoulders occurring during an epileptic seizure. Radiographs demostrated a compression-fracture of the anteromedial aspect of the humeral head bilaterally (reversed Hill-Sachs-lesions). Additionally, fractures of the lesser and greater tuberosity were diagnosed at the right site. Open reduction and internal fixation was performed in both shoulders within 12 hours. 6 months later the patient has no complaints with a free range of motion. Diagnostics, treatment and result are discussed in context with the literature.     

Gelenkrekonstruktion mit autologem Knochenzylinder und winkelstabilem Marknagel

The case of a 51-year-old patient is presented, with a humeral shaft fracture in combination with an ipsilateral reverse Hill-Sachs lesion, presumably after posterior shoulder dislocation as a result of an electrical accident followed by a fall from a ladder. After corresponding diagnostics, osteosynthesis of the shaft fracture was performed with a locked antegrade intramedullary nail. Simultaneously the reverse Hill-Sachs lesion was elevated und supplemented with the bone core that accrues during drilling of the nail entrance. In the follow-up period good fragment alignment, persistent joint stability and freedom of pain could be observed. On the basis of this case and the current literature the injury mechanism and potential therapy alternatives are discussed.     

Simultaneous anterior and posterior dislocation of hips:a case report and review of literature

The presence of anterior hip dislocation along with contralateral posterior hip dislocation in the absence of other major traumas is a distinctly rare injury pattern.We report such a case,along with a ...