Dynamic posterior stabilization of shoulder hemiarthroplasty in long-standing neglected posterior dislocation of the glenohumeral joint

Posterior dislocations of the shoulder are rare. They account for less than 3% of all shoulder dislocations. The treatment of neglected bilateral posterior dislocation of the shoulder is controversial. We present a novel operative technique to stabilize a shoulder hemiarthroplasty that we used in the treatment of a chronic posterior dislocation of a shoulder with an acute four-part fracture of the proximal humerus.     

Bilateral posterior fracture-dislocation of the shoulder: Report of two cases

Bilateral posterior fracture-dislocation of the shoulder is a very rare injury. Almost 50% of bilateral posterior dislocations are due to a convulsive seizure, rising to 90% if the dislocations are associated with fractures. Electric shock accounts for less than 5% of bilateral posterior dislocations of the shoulder. A systematization of the clinical and radiological approach, followed by an early diagnosis and proper surgical treatment is essential. Authors report 2 cases of bilateral posterior fracture-dislocation of the shoulder, one caused by a convulsive seizure and the other by an electric shock. A review of literature and a treatment protocol are also presented.     

介绍肩关节前脱位的简易复位法

目的 为临床提供4种肩关节脱位手法整复的简便方法；为手术单人操作的顺利完成提供可靠保障，减少患者痛苦。方法 其要点是让患者侧坐在椅子上．患肩以“骑跨式”放在椅背之顶端，让椅背顶端将腋下顶起，使肱骨上端自然得到一种向外推挤的力量。结果 59例患者，酌情选用4种方法之一，均由一名术者单人操作完成．省时、省力、无并发症．患者易接受。结论 这四种肩关节复位法简便易行、效果可靠，患者痛苦少，术者容易理解和掌握。     

肩关节后脱位的诊断与治疗

目的 探讨肩关节后脱位相关诊断方法的意义和治疗效果。方法 对5例漏珍的肩关节后脱闰进行创伤系列X线检查和CT扫描检查。根据伤后延误时间、临床症状和影像学检查结果选择治疗方法。3例行早期闭合复位,2例陈旧脱位中,1例行切开复位内固定,1例放弃复位。结果 CT、MRI和肩关节侧位、腋窝位、Velpeau腋窝位X线片分别显示5例、1例、2例、5例肩关节后脱位;CT和腋位X线检查同时显示伴随骨折。随访2－5年,闭合复位者UCLA评分32－35分;切开复位者UCLA评分14分;未予复位者UCLA评分22分。结论 临床上对该症认识不足是造成漏诊的主要原因,早期闭合复位可取得良好功能恢复。     

Neglected traumatic posterior dislocations of the shoulder: controversies on indications for treatment and new CT scan findings

We report seven missed traumatic posterior dislocations of the shoulder in six patients. In all seven shoulders, anteroposterior radiographs did not provide the diagnosis in the emergency room after the trauma (epileptic seizure in four patients) and diagnosis was delayed for at least 24 h. The final diagnosis was reached by clinical suspicion and computed tomography (CT) scan of the seven shoulders. Two shoulders were treated by closed reduction and three were treated by closed reduction and percutaneous pinning, although four of these five shoulders presented a defect in the humeral head involving 20%–25% of the articular surface. Two shoulders dislocated for more than 6 months were treated according to Mc Laughlin's technique modified by Hawkins instead of an arthroplasty. At a minimum follow-up of 2 years and 2 months, the functional results according to Hawkins were good in all seven shoulders. There was no recurrence of the dislocation in any patient. Radiographs showed mild degenerative changes. The establishment of indications for treatment, based on the proportion of articular surface of the humeral head involved and the time of evolution of the dislocation, needs more clinical or experimental evidence. In epileptic patients, strict control of medication is of the utmost importance. Received for publication on Jan. 7, 1999; accepted on June 23, 1999     

肩关节前脱位复位

2006年1月～2007年6月,笔者采用蹬肩外展牵引复位方法治疗新鲜肩关节前脱位25例,与牵引推拿法、Hippocrateri法等比较,优点明显。     

Posterior luxation of the shoulder joint and contralateral shoulder joint fracture dislocation: a rare combination

Summary The posterior luxation of the shoulder joint is a rarely reported and often not recognized lesion in the clinical workday. The authors present the first case of a posterior luxation of the shoulder joint in combination with an contralateral anterior shoulder joint fracture dislocation. In that case the authors stress the importance of an exact clinical and radiology diagnostic and the right way to reduce a posterior luxation of the shoulder joint. Finally they draw the readers attention to operative steps to prevent a reluxation of the shoulder joint.      

肩关节后脱位2例临床报道

肩关节脱位在临床上极为常见,北京积水潭医院根据肩、肘、髋、膝关节脱位339例患者统计,肩关节脱位占40.1%,其中,肩关节后脱位在临床上极为少见,据资料统计约占肩关节脱位的1.5%～3.8%,其     

Combination of a floating clavicle and a posterior shoulder dislocation: An “Unhappy Triad” of the shoulder girdle

We present a case of a 31-year-old man who suffered from a floating clavicle in combination with a reverse Hill-Sachs lesion of his right shoulder girdle after a bicycle accident. Operative treatment was performed using minimal-invasive and arthroscopically assisted techniques.We strongly recommend an early CT scan with later 3-dimensional reconstruction to detect and fully understand these complex injuries.     

True posterior dislocation of subtalar joint: a case report

Posterior dislocation subtalar joint is rare and usually results from a high-velocity injury. Previous reports of all complete posterior dislocations of the subtalar joint have had some degree of a rotational component. We report a case of a true complete posterior dislocation of subtalar joint with no rotation.     

True congenital dislocation of shoulder: A case report and review of the literature

The dislocation of a shoulder joint in infancy is extremely rare and is usually the result of traumatic birth injuries, a sequel to brachial plexus injury, or a true congenital dislocation of shoulder. With more advanced obstetric care, the incidence of first two types has drastically decreased. We report a case of true congenital dislocation of shoulder, second of its kind, in a child who was delivered by cesarean section thereby negating any influence of trauma. We report the case because of its rarity, and review the available literature on this topic. We also discuss the management options when encountered with such a rare case scenario.     

Capsule function following anterior dislocation: Implications for diagnosis of shoulder instability

During shoulder dislocation, the glenohumeral capsule undergoes non‐recoverable strain, leading to joint instability. Clinicians use physical exams to diagnose injury and direct repair procedures; however, they are subjective and do not provide quantitative information. Our objectives were to: (1) determine the relationship between capsule function following anterior dislocation and non‐recoverable strain; and (2) identify joint positions at which physical exams can be used to detect non‐recoverable strain in specific capsule regions. Physical exams were simulated at three joint positions including external rotation (ER) using robotic technology before and after anterior dislocation. The resulting joint kinematics, strain distribution in the capsule, and non‐recoverable strain were determined. Following dislocation, anterior translation increased by as much as 48% (0° ER: p = 0.03; 30° ER: p = 0.03; 60° ER: p < 0.01). Capsule sub‐regions with less non‐recoverable strain required more ER to detect differences in the strain ratios between the intact and injured joint. Strain ratio changes on the humeral side of the posterior axillary pouch (0.31 ± 0.32) were significant at all joint positions (0° ER: p = 0.03; 30° ER: p = 0.048; 60° ER: p = 0.04), whereas strain ratio differences on the humeral side of the anterior axillary pouch (0.18 ± 0.21) were significant only at 60° of ER (p = 0.03). Therefore, standardizing physical exams for joint position could help surgeons identify specific locations of non‐recoverable strain that may have been ignored. © 2013 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 31: 962–968, 2013     

先天性肩关节脱位并眩骨头发育不良1例

1病例资料 患儿，男，21d。出生后发现左侧上肢不活动，余肢体活动灵活，未引起患儿家长重视，但随时间增长，左上肢仍不能活动，来院就诊。查体，发育正常，营养良好，头颅及五官无畸形，颈部及甲状腺正常。     

Irreducible dislocation of the knee joint

Posterolateral knee dislocations are very rare and generally irreducible by closed reduction. It is due to interposition of various portions of medial capsule-ligamentous structure in the knee joint space. In such cases, open reduction is recommended. Only a few cases have been reported in the literature. This article presents an unusual case of irreducible knee dislocation, in which the medial femoral condyle buttonholed through the medial retinaculum and capsular structure. Closed reduction attempt was unsuccessful. Open joint reduction was performed. Direct repair of the medial collateral ligament and retinaculum, and arthroscopic assisted posterior cruciate ligament reconstruction were also performed. Arthroscopic-assisted anterior cruciate ligament reconstruction was carried out in staged operation.     

Reconstruction of the articular surface of the humeral head after locked posterior shoulder dislocation: a case report

Posterior dislocations of the glenohumeral joint are extremely rare (2–4% of all shoulder dislocations) and often associated with bone or ligamentary injuries. Though the reverse Hill-Sachs lesion is a common injury associated with posterior shoulder dislocation, there have been only few articles describing specific treatments for this type of humeral head defect. This article describes the successful operative treatment of an acute locked posterior shoulder dislocation by reconstructing the articular surface of the humeral head with the use of autologous bone graft taken from the iliac crest. The patient was doing quite well with no complaints, good range of shoulder motion and no recurrence of posterior shoulder dislocation despite several epileptic seizures, 1.5 years after surgical reconstruction of the anatomy of the humeral head. His right shoulder function revealed to be “excellent” or “good”, assessed with an absolute Constant Score of 76 points and a relative Score of 88% when compared with an age- and sex-matched normal population.