Arthroscopically assisted minimally invasive plate osteosynthesis for posterior fracture-dislocation of the shoulder

Posterior four-part fracture-dislocations of the proximal humerus: clinical and functional evaluation of osteosynthesis treatment

Objective

To evaluate patients diagnosed with posterior four-part fracture-dislocations of the proximal humerus, that were surgically treated with osteosynthesis, regarding their clinical and functional outcomes.

Methods

A prospective observational study of eight patients from the same hospital institution in the interior of São Paulo State (Brazil), through individual interviews using the UCLA, DASH, and Constant international scores. The active movements included in the scores plus the range of motion of the affected and non-affected limb were measured. The affected shoulder's radiographs were requested to verify bone conditions and the fixation of the osteosynthesis.

Results

The rating of eight patients by the international scores indicated that seven of the eight patients presented good clinical and functional evolution of the affected limb; this represents 87.5% of the evaluated individuals.

Conclusion

Surgical treatment with osteosynthesis performed during the acute period (<four weeks) leads to good results in most cases.

Locked posterior dislocation of the shoulder: A systematic review

Locked posterior dislocation of the shoulder is very rare. Seizures and trauma are the most common causes of this injury.There is no current benchmark treatment strategy for these rare cases.This study has shown that reconstruction of the shoulder joint in an anatomical way in acute and chronic cases up to 16 weeks provides good results.The purpose of this study is to evaluate the results of different treatment procedures with outcomes and to compare the results of the same procedures in acute and chronic cases. Cite this article: EFORT Open Rev 2017;3:15-23. DOI: 10.1302/2058-5241.3.160089.

Dry arthroscopy of the shoulder

A technique to perform glenohumeral arthroscopy without using arthroscopic fluid for visualization or instrumentation is presented. The patient is placed in the beach-chair position. No traction is applied. Portal placement is performed as usual. Water flow is used only sporadically to wash the joint cavity, and then it is immediately aspirated with a synoviotome suction pump. The entire exploration and instrumentation occur within a pressure-free dry joint. We have applied this technique in more than 50 patients, and in none of these cases was there a need to switch from the dry to the wet technique. By use of this surgical technique, intra-articular shoulder pathology treatment can be performed in a more accurate biomechanical and physiological scenario. It avoids many visualization and instrumentation inconveniences, as well as the risk of some major complications. Joint distension with fluid becomes unnecessary, making it possible to use medium-sized incisions to perform and simplify complex procedures.