Posterior Shoulder Dislocation Associated With the Head (Splitting) and Humeral Neck Fracture: Impact of Understanding Radiologic Signs and Experience With an Extended Deltopectoral Approach

Investigating the Effects of EMGBF Combined with Different Motion Directions on Improving Upper Limb Function, iEMC, and Pain in Patients with Shoulder Dislocation

The dislocation of the shoulder is a common complication of stroke, which is easy to occur after 3 months of stroke, with an incidence of 70%. There is no single standard for the pathogenesis of the disease, but the atrophy of the associated stability muscle, such as the triangle muscle, the oblique, and the upper muscle of the gonfield, may be the cause of the disease. In order to observe the effects of Electromyographic Biofeedback (EMGBF) combined with different motion directions on upper limb function with shoulder dislocation, a total of 84 patients with shoulder dislocation from May 2020 to February 2022 are selected for the study. The experimental results show that after treatment, upper limb motor function, iEMC, pain score, Barthel index, and quality of life score in the observation group are significantly higher than those in the control group, with statistical significance.

Humeral Head Three-Part Posterior Fracture-Dislocation Reduced through a Posterior Approach and Fixed with Blocked Threaded Wires: A Consecutive Case Series

Background and Objectives: Posterior fracture dislocations are rare. There is currently no uniformity regarding treatment. Therefore, outcomes are difficult to compare. We evaluated clinical and radiological outcomes of patients with humeral head posterior fracture dislocation treated with an open posterior reduction and then fixed with a biomechanically validated configuration of blocked threaded wires. Materials and Methods: 11 consecutive patients with humeral head three-part posterior fracture dislocation were treated by reduction through a posterior approach and fixed with blocked threaded wires. All patients were clinically and radiographically evaluated after a mean follow-up of 50 months. Results: The mean irCS was 86.1% (range: 70.5-95.3%). No significant difference was found between irCS at 6 and 12 months postoperatively and the final follow-up. Six patients noted their pain intensity as 0/10, three as 1/10, and two as 2/10. The postoperative reduction was considered as excellent in eight patients (Bahr's criteria) and good in the remaining three; at the final follow-up, reduction was excellent and good in seven and four patients, respectively. The mean neck-shaft angles at FU 0 and at the final FU were 137° and 132°, respectively. No signs of avascular necrosis, non-union, and arthritis progression were seen. No recurrence of dislocation or posterior instability symptoms were reported. Conclusions: We believe that our very satisfactory results stem from: (1) the manual reduction of the dislocation through a vertical posterior surgical approach, which does not produce further osteocartilaginous damage of the humeral head; (2) no multiple perforations of the humeral head are performed; (3) the threaded wires have a smaller diameter than the screws, therefore they preserve the bone tissue of the humeral head; (4) deperiostization or further detachment of soft tissues are not expected; (5) the adopted and validated system is stable and limits translation, torsion, and the collapse of the humeral head.

A Case of Modified McLaughlin Procedure in Neglected Posterior Shoulder Fracture Dislocation

A Hill-Sachs lesion, a posterolateral bony defect of the proximal humerus, occurs when the humerus head collides with the anterior region of the glenoid during an anterior shoulder dislocation. A posteriorly dislocated shoulder may cause a reverse Hill-Sachs lesion, which is a deficiency on the anteromedial part of the humeral head due to impaction. Avascular necrosis could result from this lesion if detection and repair are not carried out. The subscapularis tendon is separated from the smaller tuberosity using an open technique in the original McLaughlin procedure, which was initially described in 1952. In neglected cases of patients undergoing surgery after three weeks, there is no commonly accepted standard of care. Glenohumeral joint stabilization and early and full functional recovery are the two objectives of the procedure. This case report describes a modified McLaughlin surgery where the subscapularis tendon and lesser tuberosity are transferred to the reverse Hill-Sachs defect for stability. The clinical significance of our case report is that it accentuates the role of early detection and appropriate management of reverse Hill-Sachs lesion, which is often overlooked and missed in a case of posterior shoulder dislocation. The use of the modified McLaughlin procedure not only covers the defect with a bone chunk and the subscapularis tendon transfer over the head of the humerus but the stable fixation with the anchor and cannulated cancellous screw helps in early rehabilitation of the shoulder joint.

Reverse Shoulder Arthroplasty for Proximal Humerus Head-Split Fractures-A Retrospective Cohort Study

Head-split fractures are proximal humerus fractures (PHF) that result from fracture lines traversing the articular surface. While head-split fractures are rare, surgical treatment of these complex injuries can be extremely challenging and is associated with high rates of complications. Treatment using primary reverse shoulder arthroplasty (RSA) has been associated with moderate complication rates and reproducible clinical results. The aim of this study was to evaluate clinical and radiographic outcomes, and complication rates of RSA for head-split PHF. Twenty-six patients were evaluated based on Constant Score (CS) and range of motion of both shoulders and Subjective Shoulder Value (SSV). Radiographic analysis evaluated tuberosity healing, prosthetic loosening and scapular notching. Patients achieved good clinical results with a CS of 73.7 points and SSV of 82% after a mean follow-up of 50 months. The relative CS comparing operated versus the unaffected shoulder was 92%. Greater tuberosity healing was achieved in 61%. Patients who suffered a high-energy trauma reached a significantly greater functional outcome. Patients who suffered multifragmentation to the humeral head performed the worst. There were no cases of loosening; scapular notching was visible in two cases. The complication rate was 8%. RSA is an adequate treatment option with for head-split PHF in elderly patients.

Bilateral posterior fracture-dislocation of the shoulders: Two rare case reports and literature review

RATIONALE

Bilateral posterior fracture-dislocation of the shoulders occurs rarely and the diagnosis is often challenging. This injury is often missed or delayed on initial presentation, leading to continuous pain, disability, and rising medical costs. Timely diagnosis and proper treatment are very important to restore shoulder function.

PATIENT CONCERNS

Here we report 2 rare cases. Case 1 was a 53-year-old physical worker with severe pain and limited shoulder movement after an unexpected fall. Case 2 was a 55-year-old man with pain in upper limbs and shoulders after an electric shock.

DIAGNOSIS

Both of them were diagnosed as bilateral posterior fracture-dislocation of the shoulders by computed tomography (CT) scan.

INTERVENTION

After systematic preoperative evaluation, both of them were treated with open reduction and internal fixation.

OUTCOMES

After 16 months follow-up, case 1 was pain-free in both shoulders. He had returned to full activity and was satisfied with his level of function. At 24 months follow-up, both shoulders of case 2 were painless and stable with acceptable range of motion and he was able to carry out daily activities.

LESSONS

Our case reports highlight that bilateral posterior fracture-dislocation of the shoulders is easy to be missed; one way to prevent missing diagnosis is to suspect cases with pain and limited external rotation, especially those with a history of seizures, electric shock, or severe trauma; appropriate history inquiry, physical examination, proper shoulder images are the key to correct diagnosis.

Locked posterior fracture-dislocation of the shoulder

BACKGROUND AND AIM OF THE WORK

To describe a valid option for the treatment of locked posterior fracture-dislocation of the shoulder (LPFDS) and to compare it to the literature about this topic.

METHODS

We present a small case series (3 patients), with a medium follow up at 4 years and 5 months. We accurately describe our surgical strategies, underlining the choice of approach, reduction and fixation.

RESULTS

The three patients showed excellent functional and radiological results at the follow up examinations, with a full range of shoulder movements and complete regain of pre-trauma activities. A lateral approach (standard or minimally invasive), a reduction technique with a Shantz pin in the head and in the humeral shaft, and fixation with a locking plate were used in the three patients.

CONCLUSION

LPFDS is a challenging lesion, hard to recognize and to treat. Our suggested method of treatment is highly reproducible and has revealed itself to be very effective in achieving good results.

Anatomical Variations of the Pectoralis Major Muscle: Notes on Their Impact on Pectoral Nerve Innervation Patterns and Discussion on Their Clinical Relevance

BACKGROUND

The presented study attempts to classify individual anatomical variants of the pectoralis major muscle (PM), including rare and unusual findings. Rare cases of muscular anomalies involving the PM or its tendon have been presented. An attempt has also been made to determine whether anatomical variations of the PM may affect the innervation pattern of the lateral and medial pectoral nerves.

MATERIAL AND METHODS

The research was carried out on 40 cadavers of both sexes (22 males, 18 females), owing to which 80 PM specimens were examined.

RESULTS

Typical PM structure was observed in 63.75% of specimens. The most frequently observed variation was a separate clavicular portion of the PM. In one female cadaver (2.5% of specimens) the hypotrophy of the clavicular portion of the PM was noticed. In two male cadavers (5% of specimens) the fusion between the clavicular portion of the PM and the deltoid muscle was observed. In one of those cadavers, small sub-branches of the lateral pectoral nerve bilaterally joined the clavicular portion of the deltoid muscle. The detailed intramuscular distribution of certain nerve sub-branches was visualized by Sihler's stain. PM is mainly innervated by the lateral pectoral nerve. In all specimens stained by Sihler's technique, the contribution of the intercostal nerves in PM innervation was confirmed.

CONCLUSIONS

Surgeons should be aware of anatomic variations of the PM both in planning and in conducting surgeries of the pectoral region.