Results of open reconstruction of anterior glenoid rim fractures following shoulder dislocation

Introduction  The present study evaluates the clinical and radiological outcome following open reconstruction of avulsion fractures of the anterior glenoid rim in traumatic shoulder dislocation. Material and methods  A total of 20 patients (mean age 49.4 years) were treated with open reduction and cannulated screw fixation. Eighteen patients were available for clinical and radiological follow-up after 3.1 (2.0–6.5) years. Results  The average Constant Score was 78 and the average Rowe Score was 90 points. Documented complications were implant failure in one and neurological dysfunction in one patient. Radiographs revealed the bony fragment located in an unimproved displaced position in one patient and a progress in osteoarthritic changes in three patients. No recurrent subluxation or dislocation was observed. Conclusion  Open reconstruction of glenoid rim fractures is a valuable procedure regarding medium-term subjective and objective outcome measures. Recurrent dislocation, glenoid defects and early onset of osteoarthritic degeneration can be avoided.     

Irreducible acute anterior dislocation of the shoulder caused by interposed fragment of the anterior glenoid rim

Failure of manipulative reduction of acute anterior dislocation of the shoulder is extremely rare. A 55-year-old man dislocated his right shoulder when he fell heavily. Initial radiographs and computed tomographs demonstrated an anterior dislocation with fracture of the glenoid rim. Several attempts at closed reduction were unsuccessful. At the time of open reduction, the cause of failure was found to be interposition of a fragment of the anterior inferior glenoid rim in the joint. To prevent redislocation, the fragment was held in place by two Herbert mini bone screws after anatomic reduction, and the ruptured subscapularis was reattached to the lesser tuberosity. Two and a half months after surgery, the shoulder was stable with full range of motion. To the best of our knowledge, this is the first reported case of interposition of a fracture-fragment of the anterior inferior glenoid rim causing failure of reduction.     

Arthroscopic repair for anterior shoulder instability with a Bigliani type I glenoid rim fracture

This case report describes arthroscopic repair for the treatment of an anterior glenoid rim fracture associated with traumatic anterior shoulder dislocation.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 18, No 6 (July-August), 2002: pp E32     

Anterior capsulolabral reconstruction for traumatic recurrent anterior shoulder dislocation

The anterior capsulolabral reconstruction (ACLR) has been shown to yield satisfactory results predominantly in overhead athletes with atraumatic anterior shoulder instability. The purpose of this study was to assess the clinical results of patients who underwent ACLR for recurrent traumatic anterior shoulder dislocation. A retrospective review of 41 patients, mean age 29 (range: 16 to 55 years) who underwent ACLR for traumatic recurrent anterior shoulder dislocation was performed. All patients reported a traumatic anterior shoulder dislocation with subsequent recurrent instability. Seven patients had undergone previous shoulder stabilization surgery which had failed. The mean number of previous dislocations was 4.5 (range: 1 to 15). There were 31 males and 10 females, and the dominant arm was involved in 24 patients. In all cases, the capsulolabral complex was detached from the glenoid rim. The mean follow-up was 3.6 years (range: 15 to 80 months). All patients were evaluated by physical examination. The mean modified Rowe score was 93.6 (range: 65 to 100). There were 32 excellent, 5 good, 1 fair, and 2 poor results. Instability was eliminated in 38 patients (93%). Of 25 patients who engaged in recreational sports, all were able to return to their previous level of participation. One patient sustained a traumatic redislocation and underwent revision surgery. Two patients reported atraumatic recurrent subluxation with one requiring revision surgery due to persistent symptoms of instability. There was no loss of range of motion in comparison to preoperative values. Of the seven shoulders that had undergone previous surgery, all remain stable. These results indicate that a glenoid-sided capsulolabral reconstruction can restore shoulder stability in patients with recurrent traumatic anterior shoulder dislocation. Success rates comparable to those of other open anterior shoulder repair procedures can be achieved.     

The rate of recurrence of traumatic anterior dislocation of the shoulder

Summary We have reviewed the history of 154 primary, traumatic dislocations of the shoulder in order to determine the risk of recurrence. We found a recurrence rate of 68% in patients under the age of 20, after a follow-up period of 1–9 years (average 4.5 years). There was a highly significant difference (p<0.0001) in the recurrence rate of patients under, and above, 30 years of age. Twenty per cent of the patients had a concurrent minor fracture at the shoulder with 2 out of 39 of the recurrent cases (5%) and 29 of the 115 non-recurrent cases (25%); this is also a significant difference (p<0.01). Neither the need for general anaesthesia at primary injury nor the occupation of the patient was a relevant factor in the final outcome of the dislocation. Four nerve injuries were encountered (3%), with no severe sequelae at follow-up. The young patient with no concurrent fracture at the time of the primary shoulder dislocation has a high risk of recurrence.

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Résumé Afin d'évaluer le risque de récidive, on a revu 154 observations de luxations traumatiques primitives. 68% des patients âgés de moins de 20 ans ont présenté une récidive après une période variant de 1 à 9 ans (4.5 ans en moyenne). Le pourcentage de récidive, au dessus ou au dessous de l'âge de 30 ans, diffère de façon hautement significative (p<0.001). Vingt pour cent des cas présentaient également une fracture mineure de l'épaule, parmi lesquels 2 sur les 39 cas de récidive (5%) et 29 sur les 115 cas de non-récidive (25%). Cette différence est également significative (p<0.01). Ni la nécessité d'une anesthésie générale à l'occasion de la première réduction, ni le métier du patient n'étaient des facteurs influant sur le résultat final. Quatre lésions nerveuses (3%) ont été observées, aucune n'a entraîné de séquelles. Chez les patients jeunes qui présentent une première luxation de l'épaule sans fracture, le risque de récidive est très élevé.

     

肩关节镜治疗复发性肩关节前脱位

目的 对关节镜治疗复发性肩关节前脱位的疗效进行评价.方法 2001年1月至2006年3月关节镜治疗复发性肩关节前脱位患者52例,其中44例获得随访,随访时间12～54个月,平均26个月.对获得随访的44例患者的临床资料进行回顾性研究.采用美国加州洛杉矶大学肩关节评分系统(UCLA)、肩关节简明测试(SST)、Dawson评分对术后效果进行评价.采用Dawson评分对患者年龄、是否存在松弛、术前脱位频率、复位情况和病程长短等因素对术后疗效的影响进行评价.结果 获得随访的44位患者的脱位复发率为4.5%.术后UCLA、SST、Dawson评分与术前比较差异具有统计学意义,肩关节镜治疗术后优良率在91%以上.患者年龄、病程长短、术前脱位频率、是否伴有关节松弛、复位方法对治疗效果无明显影响.结论 关节镜治疗复发性肩关节前脱位手术效果较好,术后肩关节功能改善明显.     

关节镜下盂唇缝合治疗肩关节前脱位

目的探讨关节镜下盂唇缝合治疗肩关节前脱位的临床疗效。方法采用关节镜下盂唇缝合锚钉固定治疗12例肩关节前脱位患者。结果 12例肩部疼痛均消失,其中1例肩关节后伸受限。12例均获随访,时间9～24（12±8）个月。术前UCLA评分为（18.5±4.2）分,术后为（32.8±1.5）分,差异有统计学意义（P〈0.05）;肩关节前屈上举术前为（115.4±12.0）°,术后为（163.3±8.2）,°差异有统计学意义（P〈0.05）。患者均恢复原有工作、运动。结论关节镜下盂唇缝合治疗肩关节前下脱位效果良好,具有诊断与治疗一体化优点,同时可以处理合并损伤。     

Arthroscopic double-loaded single-row repair in chronic traumatic anterior shoulder dislocation

Purpose

We evaluated the clinical results of arthroscopic double-loaded single-row repair for chronic anterior shoulder dislocation.

Methods

From January 2007 to December 2008, of the 47 shoulders with chronic anterior shoulder dislocation that consecutively underwent arthroscopic double-loaded single-row repair using bio-absorbable suture anchors containing two non-absorbable braided sutures, 45 shoulders (95.7?%) had successful follow-up for a minimum of 2?years. The mean age of patients was 23.7?years, the mean frequency of dislocations before surgery was 6.8 events, and the mean interval between the initial dislocation and surgery was 47.9?months. Clinical results were evaluated using ASES, Rowe, VAS score, and range of motion before surgery and at the final follow-up.

Results

The mean number of suture anchors was 3.38 (range 2–6) and the mean number of stitches was 6.32 (range 4–10). Four of the 45 cases had recurrence (8.9?%). Of these four, three cases underwent re-operation using the same method and the other one case showed no specific discomfort except a one-time dislocation that underwent conservative treatment. The preoperative and the final follow-up ASES and Rowe scores were statistically significantly improved (P?P?P?>?0.05), but external rotation at the side was significantly decreased (P?=?0.001).

Conclusions

Arthroscopic double-loaded single-row repair using suture anchors, containing two sutures in chronic anterior shoulder dislocation, is a reliable procedure with respect to recurrence rate, range of motion, and shoulder function.     

Anatomical glenoid reconstruction via a J-bone graft for recurrent posttraumatic anterior shoulder dislocation

Objective

To reconstruct the anatomical glenoid shape in cases of osseous glenoid rim defects after recurrent posttraumatic anterior shoulder dislocation to restore stability without severely compromising the range of motion.

Indications

Osseous glenoid defects after recurrent posttraumatic anterior shoulder dislocation. Suitable for primary stabilization as well as for revision surgery in cases previously operated on.

Contraindications

Recurrent anterior shoulder dislocations without glenoid rim defects. Hyperlax shoulders with multidirectional instability. Patients over 60?years of age due to compromised bone quality. Teenage patients due to incomplete apophyseal fusion at the iliac crest.

Surgical technique

The subscapularis tendon and capsule are split. The humeral head is retracted laterally, and the glenoid defect is prepared and abraded with a rasp. A bicortical iliac crest bone block including crest and outer cortex is harvested and molded in a J-shaped manner. To incorporate the graft, a crevice on the glenoid rim is produced using a chisel. The keel is fitted into the preformed crevice with a spiked impactor. The graft??s surface is contoured using a high-speed burr.

Results

A total of 47?shoulders were followed-up after an average of 90?months (range 25?C152?months). The mean Rowe scores were 94.3 for the affected shoulder and 96.8 for the uninjured shoulder. The Constant scores reached 93.5 and 95?points, respectively. Loss of external rotation was 4.4°. In addition, 24?shoulders were followed-up by computed tomography (CT). There were no recurrences, with the exception of one traumatic graft fracture. Of 19?patients with arthropathy at follow-up, 11?already had arthropathy prior to the procedure.     

A new method of immobilization after traumatic anterior dislocation of the shoulder: a preliminary study

This preliminary prospective study was conducted to determine whether immobilization with the arm in external rotation would decrease the rate of recurrence after initial traumatic anterior dislocation of the shoulder. Forty patients with initial shoulder dislocations were assigned to (1) conventional immobilization in internal rotation (IR group, n = 20) or (2) a new method of immobilization in external rotation (ER group, n = 20). The recurrence rate was 30% in the IR group and 0% in the ER group at a mean 15.5 months. The difference in recurrence rate was even greater among those who were aged less than 30 years (45% in the IR group and 0% in the ER group). Immobilization with the arm in external rotation is effective in reducing the rate of recurrence after initial dislocation of the shoulder.     

创伤性肩关节后脱位的诊断与治疗

目的探讨创伤性肩关节后脱位的诊断方法和治疗效果。方法对2005年5月～2010年10月本院诊治的5例肩关节后脱位进行回顾性研究。5例患者中,本院漏诊1例酒精戒断症状发作后肩关节后脱位,本院及时正确诊断2例,分别为癫痫发作和车祸外伤后肩关节后脱位,外院漏诊2例,分别为车祸和坠落伤。早期正确诊断的2例中,1例行早期闭合复位,1例行切开复位;3例漏诊致陈旧性脱位患者,其中2例行改良McLaughlin手术切开治疗,1例放弃复位治疗。结果随访2～4年（平均32个月）,早期闭合复位的1例UCLA肩关节评分33分,早期正确诊断并行切开复位的1例UCLA肩关节评分31分,漏诊的陈旧性肩关节后脱位中2例手术治疗的UCLA肩关节评分分别为27分和30分,未予复位者UCLA肩关节评分22分,但随访时对结果表示满意。结论临床上对肩关节后脱位缺乏足够认识是造成漏诊的主要原因,早期诊断、早期复位是获得良好肩关节功能的重要保证。