A six months old neglected anterior shoulder dislocation managed by closed reduction and Latarjet procedure

Neglected Anterior Shoulder Dislocation With Greater Tuberosity Fracture Managed With Open Reduction and Latarjet Procedure: A Case Report

Neglected shoulder dislocation is a relatively rare occurrence characterized by structural changes in bone and soft tissue. Surgical intervention is often necessary, yet no universally accepted treatment approach exists, presenting a challenging clinical scenario. A 45-year-old female presented with an eight-month-old neglected anterior shoulder dislocation, compounded by a Hill-Sachs lesion from a previous fall. Treatment comprised open reduction in conjunction with the Latarjet procedure. Regular follow-up evaluations were conducted over three years post-surgery, revealing satisfactory outcomes including good range of motion, bony union, and absence of dislocation episodes. Managing neglected shoulder dislocations, particularly those with significant bone defects, poses unique challenges involving soft tissue contracture, bone loss, and associated fractures. Despite these complexities, open reduction combined with the Latarjet procedure demonstrated a high success rate in preventing further shoulder dislocation, albeit with a persistent risk of shoulder joint osteoarthritis.

Chronic Bilateral Anterior Shoulder Fracture-Dislocation Following Febrile Seizure After COVID-19 Vaccine: A Case Report

Although the shoulder is one of the most commonly dislocated joints in the body, bilateral gleno-humeral joint dislocation is considered rare. Due to its complexity and paucity of cases reported in the literature, it represents both a diagnostic and therapeutic challenge. We report a rare case of an adolescent boy who suffered chronic bilateral anterior shoulder dislocations with proximal humerus fracture and Hill-Sachs lesion after febrile seizure following COVID-19 vaccination. An 18-year-old male presented with bilateral proximal humerus fracture with anterior shoulder dislocation following a first-time seizure. He was managed with a bilateral Latarjet procedure and proximal humerus interlocking osteosynthesis (PHILOS) on the left side, and the right-side fracture was fixed with two 3.5 mm cannulated screws. After one year, the patient had a somewhat satisfactory outcome with a DASH (disabilities of the arm, shoulder, and hand) score of 31.8. Bilateral anterior shoulder dislocation with associated proximal humerus fracture remains one of the rare orthopedic injuries. Recurrent shoulder dislocations lead to chronic glenoid bone loss, which needs fixation along with fracture.

Neglected Anterior Shoulder Dislocation Treated With Open Reduction and Latarjet Procedure: A Case Report

According to the literature, cases of neglected anterior shoulder dislocation are extremely rare, which still presents diagnostic and treatment challenges. An extensive surgical procedure is required for their treatment. This situation is still challenging, and there is currently no accepted therapeutic protocol to resolve it. We report the case of a 30-year-old patient who had a right shoulder trauma with an unnoticed antero-medial dislocation. The treatment established was an open reduction combined with the Latarjet procedure followed by good results.

Management of Neglected Locked Anterior Dislocation of Shoulder: A Report of Two Cases

There is a paucity of literature regarding a neglected shoulder dislocation, as it is unusual to miss it clinically due to the apparent deformity. Nevertheless, in some cases, particularly those who received the primary treatment from a local bonesetter, present with neglected dislocation. No high-level studies comparing different treatment modalities in such a situation are available. Therefore, most of the treatment recommendations are based on level four studies and the literature for recurrent dislocation of the shoulder. We herewith describe two cases of neglected anterior dislocation of the shoulder, which we have managed by open reduction and Latarjet procedure in one and Bankart surgery in the other patient. Both of our patients after one-year follow-up had a painless joint with improved yet limited range of motion. This case discussion helps in learning the approach towards the treatment of these patients. It also suggests a sub-optimal functional outcome in them.

Locked anterior glenohumeral dislocation: is it always recommendable a conservative treatment?

PURPOSE

Chronic anterior shoulder dislocation represents a rare condition, and there is still lack of consensus in its treatment. Purpose of this study is to evaluate the clinical and radiological outcome of painful locked dislocation underwent shoulder replacement, with a minimum follow-up of two years. Second endpoint is to assess the glenoid bone graft, harvested from the humeral head.

METHODS

Eight patients underwent shoulder replacement for locked anterior shoulder dislocation. Four patients with a mean age of 23 y.o. were treated with Pyrocarbon-hemiarthroplasty and four patients with a mean age of 76 y.o. were treated with reverse shoulder arthroplasty. Glenoid single stage reconstruction was performed with a bone autograft harvested from the resected humeral head. Patients were observed for a clinical and radiological follow-up for a minimum period of 2 years; ASES and Constant score were assessed.

RESULTS

Pain and ROM improvement was reported in all the patients. In one case, postoperative recurrent RSA instability was found. Glenoid reconstruction was performed in seven cases, showing a good integration and no reabsorption issues in all but one cases. ASES and Constant-Murley functional outcomes were rated as excellent by 1 patient with pyrocarbon HA and 1 patient with RSA, good by 3 patients with RSA and 2 patients with HA, fair by 1 patient with HA and poor by one patient with RSA.

CONCLUSION

The treatment of locked anterior glenohumeral dislocation still represents a challenge in symptomatic patients. Shoulder replacement showed good results in young and older patients, with HA and RSA, respectively. Autograft from the humeral head is reliable for glenoid defect, even in ream and run procedure. Locked dislocation lasting more than one year, surgery is debatable for higher risk of a poor outcome and recurrent instability.

Conservative treatment of chronic unreduced shoulder dislocations in Cameroon: Key results concerning 33 cases

Introduction:

Chronic unreduced shoulder dislocations are rare in orthopaedics. The aim of this study is to report how conservative treatment of chronic unreduced shoulder dislocations is done and evaluate the functional outcome in a low-middle income environment.

Patients and methods:

This was a hospital based prospective observational study carried out from January 2008 to January 2018. Cases of unreduced shoulder dislocations of at least 1 month duration were included in the study. Closed reduction was done by progressive soft maneuvers described by Kocher. Epi Info software was used to analyze this data. Results were represented on tables to ease organization and comprehension.

Results:

One of the 33 had a bilateral chronic unreduced anterior dislocation. The ages ranged from 21 to 80 years, with a mean age of 42.71 ± 16.13 years. The male to female ratio was 3.2:1. The duration of dislocation ranged from 1 to 120 months. Majority of the cases 79.4% (n = 27) had successful closed reduction. The average score was 78.04/100, representing a good score.

Conclusion:

Although treatment by non-operative method is a challenge, fair to good functional outcome can be obtained if this procedure is carried out under general anesthesia and adequate relaxation.

Immobilization in external rotation vs internal rotation after shoulder dislocation: A systematic review and meta-analysis protocol

BACKGROUND

Dislocation of shoulder joint is the most prone to occurrence in all joints of human body, which is common in young people and has a high recurrence rate. It is mainly treated by conservative treatment. External rotation and internal rotation fixation are 2 common conservative therapies in clinical practice. Therefore, we conduct this systematic review and meta-analysis to evaluate the efficacy and safety of the 2 treatments.

METHODS

Nine electronic databases, PubMed, Web of Science, Embase, Cochrane Library, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov, CNKI, Wanfang Database and VIP Database, will be searched to find and include randomized controlled trials that meet inclusion criteria. RevMan5.3 will be used for data analysis and synthesis in this study. Subgroup analysis and sensitivity analysis will also be performed if necessary. In addition, GRADE will be used in the evaluation of evidence hierarchy.

RESULTS

This study will analyze and integrate the original evidence so far for clinical efficacy and safety of immobilization in external rotation and internal rotation on shoulder dislocation.

CONCLUSION

The conclusion of this study will conclude higher evidence and suggestions for the treatment of shoulder dislocation, so as to further guide clinical decision making.

PROSPERO REGISTRATION NUMBER

CRD42018106030.

A case report of ten-month-neglected anterior shoulder dislocation managed by open reduction combined with Latarjet procedure

INTRODUCTION

Neglected shoulder dislocation is a rare case and may be accompanied by pathological changes in bony and soft tissue structure. Therefore, it requires extensive surgical procedure. Until now, there is no standard treatment protocol to overcome this case and it is still a challenging case.

PRESENTATION OF CASE

We presented a 27-year-old male patient with deformity on his left shoulder. The patient has suffered a ten-month-neglected anterior shoulder dislocation with a Hill-Sachs lesion. The treatment was open reduction combined with Latarjet procedure. Evaluation of treatment was performed three months after surgery.

DISCUSSION

Management of a neglected shoulder dislocation, especially with significant bony defects, is challenging and cannot be managed with standard surgical technique because of severe soft-tissue contracture and imbalance as well as bone deficiency. Chronic locked anterior shoulder dislocation is a difficult condition for both patient and clinician. In addition to that, the treatment results can be unsatisfactory. Latarjet procedure has been shown to be effective for the treatment of recurrent anterior shoulder dislocation with a large glenoid osseous defect which might justify the application of this procedure for the treatment of neglected anterior shoulder dislocation.

CONCLUSION

Open reduction combined with Latarjet procedure performed for treatment of neglected anterior shoulder dislocation was found to have a high rate of successful in preventing further dislocation of the shoulder joint although the high risk of osteoarthritis of the shoulder joint can still persist.

Hippocratic method for reduction of chronic locked anterior shoulder dislocations

PURPOSE

Old shoulder dislocations are usually treated by a variety of surgical approaches. Closed reduction of chronic unreduced dislocation is less widely reported. This study was to evaluate the outcome of reduction of old anterior shoulder dislocations using the Hippocratic method.

METHODS

Between January 2008 and July 2016, patients with unilateral old shoulder dislocations included 10 women and three men with an average age of 60.00 ± 2.83 years. Eight dislocations involved the right shoulder and five the left shoulder. The average delay between dislocation and treatment was 4.46 ± 0.97 weeks (ranging from 3 weeks to 6 weeks). One case also had a greater tuberosity fracture. No patients had distal nerve or artery dysfunction. The patients were all healthy prior to dislocation, i.e., no diabetes, hypertension, or heart disease, etc. Dislocations were diagnosed according to anteroposterior shoulder X‑rays. Shoulder function was assessed using the Constant-Murley score. All manual reductions were conducted under general anesthesia using the Hippocratic method.

RESULTS

All shoulder dislocations were successfully reduced with the Hippocratic method. The mean time of closed reduction was 31.46 ± 7.60 min and the mean hospitalization time was 2.77 ± 1.09 days. No neurovascular injury or humerus fractures were noted during hospitalization. The Constant-Murley scores before reduction and after reduction were 34.31 ± 7.25 and 60.92 ± 8.95, respectively. These scores were significantly higher after reduction compared with before reduction (P < 0.01). No recurrent dislocation was observed in any patients during the follow-up period.

CONCLUSION

The closed reduction of old anterior shoulder dislocations using the Hippocratic method is not unfeasible and should be attempted in selected patients.