1
|
Kato S, Yasuma S, Joyo Y, Shiraga H, Murakami H, Waguri-Nagaya Y. Difficulty in Early Diagnosis of Bilateral Posterior Fracture-dislocation of the Shoulder Caused by an Electric Shock in a Walk-in Patient: A Case Report. J Orthop Case Rep 2024; 14:30-35. [PMID: 39035384 PMCID: PMC11258722 DOI: 10.13107/jocr.2024.v14.i07.4564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/25/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Bilateral posterior fracture-dislocation of the shoulder is a very rare injury that is commonly missed. Almost 70% of bilateral posterior dislocations are due to convulsive seizures, with electric shocks accounting for < 5% of bilateral posterior shoulder dislocations. Case Report The case of a walk-in patient, a 52-year-old man, with bilateral posterior fracture-dislocation of the shoulder caused by an electric shock is reported. Although he was initially admitted to the emergency department for observation of the potential complications of an electric shock, such as fatal arrhythmia and rhabdomyolysis, he subsequently consulted an orthopedic surgeon 4 days after the event due to persistent bilateral shoulder pain and was diagnosed using X-ray and computed tomography with bilateral posterior fracture-dislocation of the shoulder. Following open reduction and internal fixation 7 days after the injury, the upper limbs were fixed with shoulder braces at a slightly flexed and abducted position with neutral rotation for 3 weeks postoperatively followed by range of motion exercises. Twelve months after surgery, he had a Constant shoulder score of 94, an American Shoulder and Elbow Surgeon score of 100, and no shoulder re-dislocation or humeral head necrosis. Conclusion In this walk-in patient, the diagnosis of bilateral posterior fracture-dislocation of the shoulder caused by an electric shock was delayed. We believe that understanding the mechanism of this type of injury will facilitate its early diagnosis.
Collapse
Affiliation(s)
- Sakurako Kato
- Department of Orthopaedic Surgery, Nagoya City University East Medical Center, Nagoya, Japan
| | - Sanshiro Yasuma
- Department of Orthopaedic Surgery, Nagoya City University East Medical Center, Nagoya, Japan
| | - Yuji Joyo
- Department of Orthopaedic Surgery, Nagoya City University East Medical Center, Nagoya, Japan
| | - Hiroo Shiraga
- Department of Orthopaedic Surgery, Nagoya City University East Medical Center, Nagoya, Japan
| | - Hideki Murakami
- Department of Orthopaedic Surgery, Nagoya City University, Nagoya, Japan
| | - Yuko Waguri-Nagaya
- Department of Orthopaedic Surgery, Nagoya City University East Medical Center, Nagoya, Japan
| |
Collapse
|
2
|
Fiske JW, Gao S, Wilson SM, Bugbee WD, Hoenecke HR. Treatment of osteochondral injuries of the humeral head using fresh osteochondral allograft transplantation. JSES Int 2024; 8:681-685. [PMID: 39035639 PMCID: PMC11258710 DOI: 10.1016/j.jseint.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background Large osteochondral lesions of the humeral head can result from locked posterior dislocations, avascular necrosis, and osteochondritis dissecans. Fresh osteochondral allograft (OCA) transplantation is a treatment option for young patients with focal osteochondral defects of the humeral head. The purpose of this case series was to assess graft survivorship, subjective patient-reported outcomes, and satisfaction among 7 patients who underwent OCA transplantation of the humeral head. Methods We identified 7 patients who underwent humeral head OCA transplantation between 2008 and 2017. A custom questionnaire including the American Shoulder and Elbow Surgeons score, Quick Disabilities of the Arm, Shoulder, and Hand score (QuickDash), Likert satisfaction, and reoperations was mailed to each patient. Clinical failure was defined as further surgery that involved removal of the allograft. Results Median follow-up duration was 10 years (range, 4.6 to 13.5 years) with a median age of 21.6 years (range, 18.5 to 43.5 years). Most patients (86%) reported improved function and reduced pain. At the final follow-up, 71% of patients reported ongoing problems with their shoulder including pain, stiffness, clicking/grinding, limited range of motion, and instability. Return to recreational activities was high at 86% but 43% expressed limitations with activity due to their shoulder. Overall satisfaction was high at 71% with mean American Shoulder and Elbow Surgeons and QuickDASH scores at 62.4 and 29.2, respectively. Reoperation after OCA occurred in 1 patient (14%). Conclusion Among this case series of 7 patients who underwent OCA transplantation of the humeral head, patient satisfaction was high at 10-year follow-up and most returned to recreational activity although most also had persistent shoulder symptoms.
Collapse
Affiliation(s)
- Joseph W. Fiske
- Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | - Sean Gao
- Department of Orthopedic Surgery, Scripps Clinic, La Jolla, CA, USA
| | - Shane M. Wilson
- Shiley Center for Orthopaedic Research and Education at Scripps Clinic, La Jolla, CA, USA
| | | | | |
Collapse
|
3
|
van der List JP, Glover MA, Mason TW, Parikh N, Waterman BR. Low Recurrence of Instability and Satisfying Patient-Reported Outcomes Following Various Surgical Treatments of Reverse Hill-Sachs Lesions in the Setting of Posterior Instability: A Systematic Review. Arthroscopy 2024; 40:2083-2095. [PMID: 38151167 DOI: 10.1016/j.arthro.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/23/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE To systematically review the literature and report the outcomes of various surgical treatments for reverse Hill-Sachs lesions (RHSL) in the setting of posterior shoulder instability. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. All studies assessing outcomes of surgical treatment of RHSL from inception to January 2023 were identified in PubMed, Embase, and Cochrane Library. Inclusion criteria consisted of studies reporting outcomes, minimum mean 1-year follow-up, and minimum Level IV evidence. Outcomes were assessed using Forest plots with random effects models using R software. RESULTS A total of 29 studies consisting of 291 patients were included with a mean age of 42 years (range 16-88 years), 87% male gender, and mean follow-up of 4.5 years. The mean size of impacted or affected cartilage was 35%, and time from injury to surgery was mean 15 weeks. Nearly all studies were Level IV evidence, and quality of studies was low. Random effect models were performed, and data are presented as range. A low incidence of instability was noted for all surgical techniques with good patient-reported outcome measures. Most studies reported outcomes of the modified McLaughlin procedure (13 studies, 126 patients) with overall Constant-Murley Score of 65 to 92. Trends were seen towards better Constant-Murley Score and external rotation with a shorter delay between injury, and when arthroscopic and joint preserving treatments were performed. CONCLUSIONS This systematic review showed low rates of instability recurrence, reproducible range of motion, and favorable patient-reported outcome measures were reported following all treatments for RHSLs with posterior instability. There was a significant association between better outcomes and a shorter delay between injury and surgery. The level of evidence is limited, given the small and retrospective studies which can be explained by the rarity of these injuries. LEVEL OF EVIDENCE: Level IV; systematic review of Level III and IV studies.
Collapse
Affiliation(s)
- Jelle P van der List
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A..
| | - Mark A Glover
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Thomas W Mason
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Nihir Parikh
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| | - Brian R Waterman
- Department of Orthopaedic Surgery, Atrium Health Wake Forest Baptist, Wake Forest University School of Medicine, Winston-Salem, North Carolina, U.S.A
| |
Collapse
|
4
|
Rinaldi VG, Coliva F, Favero A, Alesi D, Caravelli S, Zaffagnini S, Marcheggiani Muccioli GM. From Diagnosis to Decision-Making: A Systematic Review of the Management of Reverse Hill-Sachs Lesions after Posterior Shoulder Dislocations. J Clin Med 2024; 13:2085. [PMID: 38610850 PMCID: PMC11012447 DOI: 10.3390/jcm13072085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: The aim of this study is to describe all of the possible surgical procedures that intend to treat the McLaughlin lesion (or Reverse Hill-Sachs) in posterior shoulder dislocation. (2) Methods: Google Scholar, Pubmed, and Embase were used as databases in our research. Studies reporting the results of posterior shoulder dislocations surgically treated with procedures addressing the humeral lesion were evaluated. The studies reporting results after fracture-dislocation and multidirectional instability were excluded. (3) Results: A total of 16 studies were included in our review for a total of 207 shoulders with a mean age of 41.7 years that were evaluated at a mean of 62.1 months. The Modified McLaughlin procedure and the Graft procedures were the most commonly performed. No statistically significant difference was found between the two at the evaluation of the clinical score. (4) Conclusions: Our review highlights the importance of a correct diagnosis and an accurate surgical treatment choice based on the surgeon's experience and on the patients' characteristics.
Collapse
Affiliation(s)
- Vito Gaetano Rinaldi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Federico Coliva
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Antongiulio Favero
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Domenico Alesi
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
| | - Silvio Caravelli
- Bentivoglio Orthopaedic Unit, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy;
| | - Stefano Zaffagnini
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Via San Vitale, 40125 Bologna, Italy
| | - Giulio Maria Marcheggiani Muccioli
- II Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy; (V.G.R.); (A.F.); (D.A.); (S.Z.); (G.M.M.M.)
- Dipartimento di Scienze Biomediche e Neuromotorie DIBINEM, University of Bologna, Via San Vitale, 40125 Bologna, Italy
| |
Collapse
|
5
|
Berk AN, Rao AJ, Hysong AA, Ifarraguerri AM, Trofa DP, Schiffern SC, Connor PM, Hamid N, Saltzman BM. Clinical and radiographic outcomes of the modified McLaughlin procedure for locked posterior dislocation of the shoulder: a systematic review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2024; 4:8-14. [PMID: 38323196 PMCID: PMC10840568 DOI: 10.1016/j.xrrt.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Background Multiple treatment options for locked posterior dislocation of the shoulder (LPDS) have been described, including the modified McLaughlin procedure. The purpose of this review, therefore, was to perform a systematic review of the literature to synthesize the available data reporting on the clinical and radiographic outcomes of patients undergoing the modified McLaughlin procedure for the treatment of LPDS. Methods A systematic review of the PubMed Central, MEDLINE, Embase, Scopus, Web of Science, and Cochrane Library databases from inception through January 2023 was performed. Outcomes studies reporting on clinical and radiographic outcomes in patients undergoing the modified McLaughlin procedure for LPDS were included. Postoperative complications and episodes of recurrent instability were noted. Results A total of 1322 studies were initially identified, of which 9 were deemed eligible for inclusion in our review. Among included studies, a total of 97 shoulders (96 patients) with a mean age of 37.7 years (range, 26-51) were identified. The most common mechanisms of injury included trauma, seizure, and electrocution. Reverse Hill-Sachs lesions ranged in size from 20% to 50% of the humeral head articular surface. At final follow-up, the weighted mean University of California at Los Angeles shoulder score, Constant-Murley Score, American Shoulder and Elbow Surgeons shoulder score, and visual analog scale for pain score were 29 (range, 27-31), 75 (range, 65-92), 92 (range, 83-98), and 1.9 (range, 1-2.4), respectively. Postoperative Constant-Murley Score and University of California at Los Angeles scores were highest in the one study reporting exclusively on treatment during the acute period. Weighted mean postoperative forward flexion, abduction, external rotation, and internal rotation were 154° (range, 102-176), 144° (range, 118-171), 64° (range, 44-84), and 47° (range, 42-56), respectively. Osteointegration of the lesser tuberosity was noted in all patients at the final follow-up. Postoperative complications occurred in one patient (1.0% of cohort); a screw migration successfully treated with operative removal. Recurrent instability was noted in two epileptic patients (2.1% of cohort). Conclusion The literature surrounding the use of the modified McLaughlin procedure for LPDS remains sparse. This review demonstrates that this procedure is associated with favorable clinical and radiographic outcomes with overall low rates of complication and recurrent instability, especially when the time from injury to surgery is minimized. These findings illustrate that in patients presenting with LPDS and a reverse Hill-Sachs lesion between 20% and 50% of the humeral head articular surface, the modified McLaughlin procedure is a safe and effective treatment option.
Collapse
Affiliation(s)
- Alexander N. Berk
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Allison J. Rao
- University of Minnesota Physicians, University of Minnesota – Department of Orthopedic Surgery, Minneapolis, MN, USA
| | | | | | - David P. Trofa
- Department of Orthopaedics, New York Presbyterian, Columbia University Medical Center, New York, NY, USA
| | - Shadley C. Schiffern
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Patrick M. Connor
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Nady Hamid
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| | - Bryan M. Saltzman
- OrthoCarolina – Sports Medicine Center, Charlotte, NC, USA
- OrthoCarolina Research Institute, Charlotte, NC, USA
- Atrium Health – Musculoskeletal Institute, Charlotte, NC, USA
| |
Collapse
|
6
|
Hong L. Bilateral Anterior Shoulder Dislocations Following a Clozapine-Induced Seizure. Cureus 2023; 15:e45778. [PMID: 37872936 PMCID: PMC10590618 DOI: 10.7759/cureus.45778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/25/2023] Open
Abstract
Posterior shoulder dislocations are a recognised complication of generalised seizure episodes. Although less frequent, anterior shoulder dislocations are now being acknowledged as an emerging consequence. Particularly when they occur bilaterally, they can contribute to diagnosing a seizure disorder in a patient who shows no other signs during the post-ictal period. This article presents a case of bilateral anterior shoulder dislocations in an otherwise physically healthy young Sudanese gentleman following a generalised seizure episode on clozapine for a schizoaffective disorder. The case aims to raise awareness of the occurrence of this phenomenon and emphasises the importance of timely diagnostic testing, seizure prophylaxis, and follow-up to minimise the risk of further seizure episodes and potential consequences. Additionally, there is a discussion regarding the utility of monitoring clozapine concentrations.
Collapse
Affiliation(s)
- Lewis Hong
- Intensive Care Unit, Royal Perth Hospital, Perth, AUS
| |
Collapse
|
7
|
Feng D, Jiang Y, Kang X, Song Z, Zhu Y, Zhang J, Zhang K, Wang Z. Assessment of surgical management for locked fracture-dislocations of the proximal humerus in patients of different ages. Heliyon 2023; 9:e16508. [PMID: 37292318 PMCID: PMC10245004 DOI: 10.1016/j.heliyon.2023.e16508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/10/2023] Open
Abstract
Background Locked fracture-dislocation of the proximal humerus (LFDPH) is a very severe complex injury; neither arthroplasty nor internal plating are fully satisfactory. This study aimed to evaluate different surgical treatments for LFDPH to determine the optimal option for patients of different ages. Methods From October 2012 to August 2020, patients who underwent open reduction and internal fixation (ORIF) or shoulder hemiarthroplasty (HSA) for LFDPH were retrospectively reviewed. At follow-up, radiologic evaluation was performed to evaluate bony union, joint congruence, screw cut-out, avascular necrosis of the humeral head, implant failure, impingement, heterotopic ossification, and tubercular displacement or resorption. Clinical evaluation comprised the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire and Constant-Murley and visual analog scale (VAS) scores. Additionally, intraoperative and postoperative complications were assessed. Results Seventy patients (47 women and 23 men) with final evaluation results qualified for inclusion. Patients were divided into three groups: group A: patients aged under 60 years who underwent ORIF; group B: patients aged ≥60 years who underwent ORIF; and group C: patients who underwent HSA. At a mean follow-up of 42.6 ± 26.2 months, function indicators, namely shoulder flexion, and Constant-Murley and DASH scores, in group A were significantly better than those in groups B and C. Function indicators in group B were slightly but not significantly better compared with group C. Regarding operative time and VAS scores, there were no significant differences between the three groups. Complications occurred in 25%, 30.6%, and 10% of the patients in groups A, B, and C, respectively. Conclusions ORIF and HSA for LFDPH provided acceptable but not excellent results. For patients aged <60 years, ORIF might be optimal, whereas, for patients aged ≥60 years, both ORIF and HSA provided similar results. However, ORIF was associated with a higher rate of complications.
Collapse
Affiliation(s)
- Dongxu Feng
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an 710054, Shaanxi, China
| | - Yuxuan Jiang
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an 710054, Shaanxi, China
| | - Xiaomin Kang
- Center for Translational Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi, China
| | - Zhe Song
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an 710054, Shaanxi, China
| | - Yangjun Zhu
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an 710054, Shaanxi, China
| | - Jun Zhang
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an 710054, Shaanxi, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an 710054, Shaanxi, China
| | - Zhan Wang
- Department of Orthopaedic Trauma, Hong Hui Hospital, Xi'an Jiaotong University School of Medicine, Xi'an 710054, Shaanxi, China
| |
Collapse
|
8
|
Xiong F, Yin Q, Wang J, Wei C, Gu S, Liu Y. A novel modified McLaughlin surgery for treating locked chronic posterior shoulder dislocation. BMC Musculoskelet Disord 2023; 24:114. [PMID: 36765319 PMCID: PMC9921029 DOI: 10.1186/s12891-023-06221-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Posterior shoulder dislocation is an uncommon orthopaedics injury and is frequently missed or misdiagnosed, accounting for 2%-4% of all shoulder dislocations, and is associated with the reverse Hill-Sachs lesion. Once posterior shoulder dislocation develops into a chronic disease, it will bring a lot of trouble to the treatment, especially in repairing the humeral defects. Surgical strategies are also developing and innovating to deal with this injury, including transfer of subscapularis tendon or lesser tubercle, humeral rotational osteotomy, autogenous bone graft or allograft. Shoulder replacement seems to be the ultimate and only option when the injury becomes irreparable, although some studies have shown unsatisfactory follow-up results. Considering no gold-standard treatment for locked posterior shoulder dislocation, we described a novel modified McLaughlin procedure for locked chronic posterior shoulder dislocation and evaluated the functional outcomes. METHODS This study included five locked chronic posterior shoulder dislocation patients with an associated reverse Hill-Sachs lesion, in which the compression surface covered 30-40% of the humeral head. The mean period from injury to receiving surgery was 11.6 weeks (6-24 weeks). All five patients underwent the modified McLaughlin procedure, mainly divided into three steps, including open reduction, transfer of the partial lesser tuberosity and artificial bone to repair the reverse Hill-Sachs defects. The kernel technique was to fix the transferred tuberosity with two lag screws and strengthen it with two Ethibond sutures. The Constant-Murley score (CMS), the range of shoulder motion and the complications were recorded to assess and compare the functional situation of the shoulder postoperatively and postoperatively. RESULTS After an average of 19.8 months (12-30) of follow-up, the mean CMS improved to 85.8 ± 4.9 (79-91) compared with 46.0 ± 4.5 (40-52) preoperatively, which showed a significant difference (p = 0.001). In the final follow-up, all five patients showed no symptoms of shoulder instability, and there was no pain or limited activity in daily life, thus all patients were satisfied with the results. CONCLUSION Repairing the reverse Hill-Sachs lesion by transferring the partial lesser tuberosity combined with artificial bone fixed by lag screws and sutures can ensure shoulder stability and provide pain relief and good function in patients with locked chronic posterior shoulder dislocation associated with the humeral head defect.
Collapse
Affiliation(s)
- Fei Xiong
- grid.263761.70000 0001 0198 0694Department of Orthopaedics, Wuxi 9Th People’s Hospital Affiliated to Soochow University, NO.999 Liangxi Road, Wuxi, China ,grid.263761.70000 0001 0198 0694Orthopaedic Institute, Medical College, Soochow University, NO.178 Ganjiang East Road, Suzhou, China
| | - Qin Yin
- grid.263761.70000 0001 0198 0694Department of Orthopaedics, Wuxi 9Th People’s Hospital Affiliated to Soochow University, NO.999 Liangxi Road, Wuxi, China
| | - Jian Wang
- grid.263761.70000 0001 0198 0694Department of Orthopaedics, Wuxi 9Th People’s Hospital Affiliated to Soochow University, NO.999 Liangxi Road, Wuxi, China
| | - Changbao Wei
- grid.263761.70000 0001 0198 0694Department of Orthopaedics, Wuxi 9Th People’s Hospital Affiliated to Soochow University, NO.999 Liangxi Road, Wuxi, China
| | - Sanjun Gu
- grid.263761.70000 0001 0198 0694Department of Orthopaedics, Wuxi 9Th People’s Hospital Affiliated to Soochow University, NO.999 Liangxi Road, Wuxi, China
| | - Yu Liu
- Department of Orthopaedics, Wuxi 9Th People's Hospital Affiliated to Soochow University, NO.999 Liangxi Road, Wuxi, China.
| |
Collapse
|
9
|
Schumacher KM, Moravec A, Jonas ME, Tayag DL, Choi JY. Bilateral posterior shoulder fracture dislocations from seizures due to hyponatremia: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2023; 3:94-100. [PMID: 37588068 PMCID: PMC10426474 DOI: 10.1016/j.xrrt.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Anna Moravec
- Department of Orthopaedic Surgery, The Guthrie Clinic, Sayre, PA, USA
| | - Margaret E. Jonas
- Department of Orthopaedic Surgery, The Guthrie Clinic, Sayre, PA, USA
| | - Daniel L. Tayag
- Department of Orthopaedic Surgery, The Guthrie Clinic, Sayre, PA, USA
| | - Joseph Y. Choi
- Department of Orthopaedic Surgery, The Guthrie Clinic, Sayre, PA, USA
- The Geisinger Commonwealth School of Medicine, Scranton, PA, USA
| |
Collapse
|
10
|
Haritinian EG, Stoica IC, Popescu R, Gheorghievici GL, Nové-Josserand L. Treatment and outcomes of chronic locked posterior shoulder dislocations: a retrospective case series. BMC Musculoskelet Disord 2023; 24:82. [PMID: 36721138 PMCID: PMC9887796 DOI: 10.1186/s12891-023-06200-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/25/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Posterior shoulder dislocations are rare injuries that are often missed on initial presentation. Cases left untreated for more than three weeks are considered chronic, cannot be reduced closely (they become locked) and are usually associated with a significant reverse Hill-Sachs defect. The aim of this study was to evaluate the outcomes of chronic locked posterior shoulder dislocations treated with the McLaughlin procedure (classic or modified). METHODS This retrospective study included 12 patients with chronic locked posterior shoulder dislocation operated on between 2000 and 2021 by two surgeons in two institutions. Patients received a thorough clinical examination and radiological assessment before and after surgery. Shoulders were repaired with the McLaughlin or modified McLaughlin procedure. Outcomes were assessed by comparing pre- and postoperative values of clinical variables. RESULTS Most of the dislocations were of traumatic origin. The average delay between dislocation and surgical reduction was 13.5 ± 9.7 weeks. Postoperative clinical outcomes were favourable, with an average subjective shoulder value of 86.4 ± 11.1 and a normalized Constant -Murley score of 90 ± 8.3. None of the patients had a recurrence of shoulder dislocation, but one patient developed avascular necrosis of the humeral head and two patients developed glenohumeral osteoarthritis. CONCLUSIONS In this group of patients with chronic locked posterior shoulder dislocation, the clinical outcomes of McLaughlin and modified McLaughlin procedures were satisfactory, even when surgery was significantly delayed.
Collapse
Affiliation(s)
- Emil George Haritinian
- grid.8194.40000 0000 9828 7548Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu, 020021 Bucharest, Romania ,Foișor Orthopaedic Hospital, 35-37 Ferdinand I, 021382 Bucharest, Romania
| | - Ioan Cristian Stoica
- grid.8194.40000 0000 9828 7548Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu, 020021 Bucharest, Romania ,Foișor Orthopaedic Hospital, 35-37 Ferdinand I, 021382 Bucharest, Romania
| | - Roman Popescu
- grid.8194.40000 0000 9828 7548Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu, 020021 Bucharest, Romania
| | - Gavril Lucian Gheorghievici
- grid.8194.40000 0000 9828 7548Carol Davila University of Medicine and Pharmacy, 37 Dionisie Lupu, 020021 Bucharest, Romania ,Foișor Orthopaedic Hospital, 35-37 Ferdinand I, 021382 Bucharest, Romania
| | - Laurent Nové-Josserand
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008 Lyon, France
| |
Collapse
|
11
|
Diniz SE, Vale J, Fonte H, Xará-Leite F, Barros LH, Claro R. Asymmetric Bilateral Chronic Shoulder Dislocation in a Young Patient - A Rare Case Report. J Orthop Case Rep 2022; 12:91-96. [PMID: 36874885 PMCID: PMC9983375 DOI: 10.13107/jocr.2022.v12.i10.3382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/04/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction Chronic shoulder dislocations are infrequent and can be easily overlooked unless a carefully clinical history, physical examination, and radiographic evaluation are undertaken. Bilateral simultaneous instability is almost pathognomonic for a convulsive disorder. To the best of our knowledge, we describe the first case of asymmetric bilateral chronic dislocation. Case Report A 34-year-old male patient with a history of epilepsy and schizophrenia and multiple seizure episodes, suffered a bilateral asymmetric shoulder dislocation. Radiological examination revealed a posterior shoulder dislocation of the right shoulder with a severe reverse Hill-Sachs lesion comprising more than 50% of the humeral head surface, while on the left shoulder, a chronic anterior shoulder dislocation with a Hill-Sachs lesion of moderate dimension. On the right shoulder, a hemiarthroplasty was performed, and on the left, a stabilization with Remplissage Technique, subscapularis plication, and temporary trans-articular Steinmann pin fixation was done. After bilateral rehabilitation, the patient showed residual pain in the left shoulder and slight range of motion limitation. There were no new episodes of shoulder instability. Conclusion Our aim is to emphasize the importance of being alert to flag patients and make a prompt and accurate diagnosis of acute shoulder instability episodes, to avoid unnecessary morbidity, as well as of a high index of suspicion when a history of seizures is present. Despite the uncertain prognosis of a bilateral chronic shoulder dislocation functional results, the surgeon must take into consideration the patient's age, functional demand, and expectations to define the best treatment strategy.
Collapse
Affiliation(s)
- Sara Elisa Diniz
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal.,Department of Orthopedics, Shoulder Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Vale
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal.,Department of Orthopedics, Shoulder Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Hélder Fonte
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal.,Department of Orthopedics, Shoulder Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Francisco Xará-Leite
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal.,Department of Orthopedics, Shoulder Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Luís Henrique Barros
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal.,Department of Orthopedics, Shoulder Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rui Claro
- Department of Orthopaedics, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal.,Department of Orthopedics, Shoulder Unit, Centro Hospitalar Universitário do Porto, Porto, Portugal
| |
Collapse
|
12
|
Mittal R, Jain S, Gamanagatti S. Chronic posterior dislocation of shoulder. J Clin Orthop Trauma 2022; 31:101926. [PMID: 35799881 PMCID: PMC9253901 DOI: 10.1016/j.jcot.2022.101926] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/04/2022] [Accepted: 06/17/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Chronic posterior dislocation of shoulder (PDS) is an uncommon injury and there are very few publications describing its different injury patterns and their treatment. This study was carried out to study the associated injuries in chronic PDS, which can help to classify and guide the treatment. METHODS We retrospectively studied 16 chronic posterior dislocation of shoulder. CT scan was used to classify the injury based on the amount of bone loss in humeral head, malunion of greater tuberosity and malunion of proximal humerus metaphysis. Visual analogue score (VAS) for pain, university of California Los Angles (UCLA) shoulder score and American shoulder and elbow surgeon (ASES) shoulder score were recorded pre operatively and at an average of 27 months post operatively. RESULTS - Type A1 injury was PDS with <50% humeral head bone loss with intact greater tuberosity (GT). It was managed by modified McLaughlin procedure (MMP). Type A2 injury was PDS with >50% bone loss with intact GT. It was managed by hemi-replacement (HRA). Type B1 injury was PDS with <50% bone loss with severe GT malunion. It was managed by MMP and corrective osteotomy of GT. Type B2 injury was PDS with >50% bone loss and severe GT malunion. It was managed by reverse shoulder arthroplasty (RSA). Type C1 injury was PDS with <50% bone loss and metaphyseal malunion. It was managed by MMP and osteotomy of proximal humeral metaphysis. Type C2 injury was PDS with >50% bone loss and metaphyseal malunion. It was managed by HRA. The VAS, UCLA score and ASES score improved significantly after the surgery in all cases. There was no recurrence of the instability. CONCLUSIONS We concluded that chronic PDS could have fractures of tuberosities and/or proximal metaphysis in addition to bone loss in humeral head. The treatment is guided by all three factors-amount of bone loss in humeral head, malunion of GT and proximal humeral metaphysis. The proposed classification can help in choosing the optimum treatment out of joint salvage procedure, anatomic shoulder replacement and reverse shoulder arthroplasty.
Collapse
Affiliation(s)
- Ravi Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India,Corresponding author.
| | - Siddharth Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | | |
Collapse
|
13
|
Cohen M, Fonseca R, Galvão Amaral MV, Monteiro MT, Motta Filho GR. Treatment of chronic locked posterior dislocation of the shoulder with the modified McLaughlin procedure. J Shoulder Elbow Surg 2022; 31:100-106. [PMID: 34216784 DOI: 10.1016/j.jse.2021.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 05/16/2021] [Accepted: 05/23/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Locked posterior dislocation of the shoulder (LPDS) is a challenging condition for the orthopedic surgeon. The problem with cases of chronic LPDS is that they may result in worse clinical outcomes because the size of the reverse Hill-Sachs lesion and cartilage damage can increase over time. Multiple treatment strategies have been reported in the literature for the treatment of chronic cases. The purpose of this study was to report our experience with the modified McLaughlin technique for the treatment of chronic LPDS and evaluate the mid- and long-term functional outcomes. METHODS This was a retrospective single-center study including a consecutive series of 10 patients who underwent the modified McLaughlin procedure for the treatment of chronic LPDS. The time between dislocation and treatment ranged from 6 weeks to 14 months (mean, 20.9 weeks). Postoperative imaging and functional evaluation were performed with a minimum of 2 years' follow-up (range, 24-110 months). Functional outcomes were assessed by means of a visual analog scale score for pain and patient satisfaction regarding the operation, the Constant-Murley score, and the University of California, Los Angeles shoulder rating scale. RESULTS The mean follow-up period was 59.4 months (range, 24-110 months). Range of motion improved significantly after surgery: Mean forward flexion improved from 71° ± 5° to 126°± 37° (P < .001), mean external rotation improved from 7°± 7° to 52° ± 18° (P = .012), and mean internal rotation improved from gluteal region ± 1 vertebral level to L1 ± 4 vertebral levels (P = .001). Functional outcome measures demonstrated significant improvements: The mean Constant-Murley score improved from 22 ± 2.4 (range, 20-26) to 65 ± 21.5 (P < .001); the mean University of California, Los Angeles score improved from 9.8 ± 1.3 (range, 8-12) to 27 ± 9.7 (P < .001); and the mean visual analog scale score improved from 4.6 ± 0.8 (range, 3-6) to 2.4 ± 2.3 (P < .001). Of the patients, 8 (80%) were satisfied with the procedure. The 2 remaining cases had a delay from injury to diagnosis > 6 months and evolved with poor functional outcomes and severe glenohumeral degenerative joint disease. There were no cases of recurrent dislocation, infection, or neurologic injury during the follow-up. CONCLUSION Our study findings demonstrated that the modified McLaughlin procedure showed good results over a 2-year minimum follow-up period. The clinical outcomes of this procedure are worse when there is a delay from injury to diagnosis > 6 months.
Collapse
Affiliation(s)
- Marcio Cohen
- Department of Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil.
| | - Raphael Fonseca
- Department of Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| | - Marcus Vinicius Galvão Amaral
- Department of Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| | - Martim Teixeira Monteiro
- Department of Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| | - Geraldo Rocha Motta Filho
- Department of Shoulder and Elbow Surgery, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| |
Collapse
|
14
|
Valdivia Zúñiga CA, Fulvi AN. Fatal Outcome After Reduction of a Superior Shoulder Dislocation, A Case Report and Literature Review: A Case Report and Literature Review. JBJS Case Connect 2021; 11:01709767-202109000-00076. [PMID: 35102041 DOI: 10.2106/jbjs.cc.21.00128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
CASE An 81-year-old woman presented a superior glenohumeral dislocation after a low-energy fall, with a mechanism of axial load while the shoulder was in adduction and extension. After successful closed reduction, the patient presented sudden symptoms of severe vascular injury with a protruding axillary hematoma and hypovolemic shock. CONCLUSION Superior shoulder dislocations and vascular injuries are extremely rare among shoulder dislocations, especially after low-energy trauma. Vascular injuries may result in limb compromise and death. We highlight the importance of high clinical suspicion, particularly in superior dislocations, and the importance of prompt management of vascular complications to avoid catastrophic outcomes.
Collapse
|
15
|
Romano AM, Edwards TB, Nastrucci G, Casillo P, Di Giunta A, Zappia M, Susanna M, Ascione F. Arthroscopic reduction and subscapularis remplissage (ARR) of chronic posterior locked shoulder dislocation leads to optimized outcomes and low rate of complications. Knee Surg Sports Traumatol Arthrosc 2021; 29:2348-2355. [PMID: 33074421 DOI: 10.1007/s00167-020-06317-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Unrecognized posterior shoulder dislocation with a concomitant humeral head fracture affects joint function and no consensus exists regarding treatment. The present study analyses clinical and radiographic outcomes of a novel arthroscopic technique for reducing chronic locked posterior shoulder dislocation associated with subscapularis remplissage. METHODS The study comprises a retrospective analysis of consecutive chronic posterior locked shoulders (CPLS) with minimum 2-years follow-up of patients who had undergone McLaughlin technique arthroscopic modification for the treatment of CPLS with a reverse Hill-Sachs lesion. Active range of motion (ROM), Western Ontario (WOSI) and Constant Score (CS), were evaluated pre- and postoperatively. Plain radiographs and magnetic resonance imaging (MRI) scans were collected pre- and post-operatively, recording bone defect, osteoarthritis, cuff integrity/fatty infiltration, and the grade of filling of the reverse Hill-Sachs. RESULTS Twelve male patients with a mean follow-up of 37.3 months ± 10.5 (range, 24-58) were included. Mean WOSI and CS scores improved from 41 to 92 and 28 to 94 points, respectively. ROM measurements all had significantly increased at final follow-up, with no significant differences in arm rotation. No defects were left unfilled at final MRI examination. CONCLUSION The results of this uncontrolled study with a limited number of patients confirm that arthroscopic reduction and subscapularis remplissage is a highly effective and satisfactory treatment method resulting in no shoulder rotation deficits. LEVEL OF EVIDENCE Level IV.
Collapse
Affiliation(s)
- Alfonso M Romano
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy.,Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via A. Manzoni 220, 80123, Napoli, Italy
| | - T Bradley Edwards
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
| | | | - Pasquale Casillo
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy
| | - Angelo Di Giunta
- Orthopaedic Division of Policlinico 'G.B. Morgagni', Catania, Italy
| | - Marcello Zappia
- Department of Medicine and Health Sciences, Università del Molise, Campobasso, Italy
| | | | - Francesco Ascione
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy. .,Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via A. Manzoni 220, 80123, Napoli, Italy.
| |
Collapse
|
16
|
Posterior Shoulder Dislocation with Engaging Reverse Hill-Sachs Lesion: A Retrospective Study of Ten Patients Treated with Arthroscopy or Open Reduction and Stabilization. J Clin Med 2021; 10:jcm10071410. [PMID: 33915791 PMCID: PMC8037443 DOI: 10.3390/jcm10071410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/09/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022] Open
Abstract
This study compares two surgical techniques used to treat patients with posterior shoulder dislocation with an engaging reverse Hill–Sachs lesion. We assessed ten patients who were treated at the Surgical Orthopedic and Traumatological Institute (ICOT) of Latina and the Clinic of Orthopedic and Traumatological Surgery of the ASST Sette Laghi of Varese between 2016 and 2019. The patients were divided into two groups: the first comprising six patients who underwent the open surgery McLaughlin procedure as modified by Neer, the second including four patients who underwent the arthroscopic McLaughlin procedure. All patients received postoperative rehabilitation to achieve the best possible functional recovery of the affected shoulder. We then assessed the shoulder range of motion, the pain level, and the impact on quality of life with four tests: the Constant Scale, the Simple Shoulder Test (SST), the OXFORD Scale, and The University of California—Los Angeles (UCLA) Shoulder Scale. The mean scores of the first group were: 81.3 ± 9.8 SD (Constant Scale), 10.8 ± 1.06 SD (SST), 42.5 ± 5.4 SD (Oxford Scale), 30.8 ± 3.02 SD (UCLA Shoulder Scale); we calculated the following mean scores in the second group: 80.25 ± 4.1 SD (Constant Scale), 11.5 ± 0.8 SD (SST), 42 ± 4.06 SD (Oxford Scale), 32 ± 2.9 SD (UCLA Shoulder Scale). We found no significant differences between the two groups.
Collapse
|
17
|
Bilateral neglected posterior dislocation of the shoulder treated by reverse arthroplasty and contralateral osteochondral autograft. A case report. Trauma Case Rep 2021; 33:100455. [PMID: 33851000 PMCID: PMC8038943 DOI: 10.1016/j.tcr.2021.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 11/23/2022] Open
Abstract
Bilateral posterior dislocation of the glenohumeral joint is an uncommon event, that can be missed at the initial presentation. We report the case of a 76-year old woman, who suffered a traumatic bilateral posterior dislocation, that was diagnosed three months later. She underwent surgical treatment on both shoulders in a single stage. Since the right shoulder showed a defect of the articular surface >50%, a reverse shoulder arthroplasty was performed on this side. The resected portion of the humeral head was retrieved and used as osteochondral graft to fill the reverse Hill-Sachs lesion of the left shoulder. At 18-month follow up, the patient was pain-free and had recovered excellent shoulder function on both sides: Constant score was 79 for the right shoulder and 88 for the left one. X-rays showed a grade 1 scapular notch of the right reverse prosthesis and good incorporation of the graft in the left shoulder, with no evidence of degenerative joint changes. Neglected posterior dislocations of the shoulder can be surgically treated by replacement or reconstruction. In case of bilateral injuries, the surgeon should carefully evaluate the pathoanatomy of both glenohumeral joints in order to choose and plan the most suitable procedure. If shoulder replacement is required on one side, the resected portion of the humeral head can be used as osteochondral autograft for a reconstruction procedure in the opposite side. The choice is influenced by several variables and decision-making might be challenging.
Collapse
|
18
|
Zhao J. Arthroscopic Reduction of a Chronic Locked Posterior Shoulder Dislocation. Arthrosc Tech 2020; 9:e2063-e2070. [PMID: 33381420 PMCID: PMC7768308 DOI: 10.1016/j.eats.2020.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/29/2020] [Indexed: 02/03/2023] Open
Abstract
Posterior shoulder dislocation is a rare condition. It is easily overlooked and often appears in a chronic locked status, which makes the reduction difficult, even through open procedures. Few reports in the literature have described an isolated arthroscopic reduction because it is difficult to elevate the humeral head to the level of the glenoid surface and obtain anterior-posterior soft-tissue balance. On the basis of an analysis of the mechanisms of the locking of the humeral head and the soft-tissue imbalance, we describe a set of arthroscopic shoulder release and reduction techniques, which include mainly the removal of rotator interval tissue; a thorough subscapularis release from the coracoid, the conjoined tendon, and the glenoid; and a 360° capsule-muscle release from the glenoid and the scapula. The described technique is an effective method to obtain a medial-to-lateral humeral head reduction and anterior-to-posterior soft-tissue balance. The introduction of this technique will provide a practical tool for surgeons to realize an arthroscopic shoulder reduction in the case of a chronic locked posterior shoulder dislocation.
Collapse
Affiliation(s)
- Jinzhong Zhao
- Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233, China.
| |
Collapse
|
19
|
Dimock R, Memon K, Consigliere P, Polyzois I, Imam MA, Narvani AA. Posterior Shoulder Instability: The Augmented McLaughlin Procedure. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:729-733. [PMID: 33313355 PMCID: PMC7718575 DOI: 10.22038/abjs.2020.44481.2224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 02/01/2020] [Indexed: 06/12/2023]
Abstract
Posterior shoulder dislocation, whilst uncommon, is frequently missed and often associated with a significant defect on the antero-medial aspect of the humeral head (the reverse Hill-Sachs lesion). Several techniques for stabilisation have been described, depending on the size of the lesion. We describe an additional technique for stabilising the shoulder following posterior dislocation by augmenting the reverse Hill-Sachs lesion with layers of extracellular matrix, thus further filling the defect.
Collapse
Affiliation(s)
- Richard Dimock
- Rowley Bristow Orthopaedic Unit, Ashford and St Peter’s Hospital NHS Foundation Trust, Chertsey, Surrey, UK
| | - Kashif Memon
- Rowley Bristow Orthopaedic Unit, Ashford and St Peter’s Hospital NHS Foundation Trust, Chertsey, Surrey, UK
| | - Paolo Consigliere
- The Reading Shoulder Unit, Royal Berkshire Hospital NHS Foundation Trust, Reading, UK
| | - Ioannis Polyzois
- Rowley Bristow Orthopaedic Unit, Ashford and St Peter’s Hospital NHS Foundation Trust, Chertsey, Surrey, UK
| | - Mohamed A. Imam
- Rowley Bristow Orthopaedic Unit, Ashford and St Peter’s Hospital NHS Foundation Trust, Chertsey, Surrey, UK
| | - A. Ali Narvani
- Rowley Bristow Orthopaedic Unit, Ashford and St Peter’s Hospital NHS Foundation Trust, Chertsey, Surrey, UK
- Fortius Clinic, London, UK
| |
Collapse
|
20
|
Branca Vergano L, Landi S, Monesi M. Locked posterior fracture-dislocation of the shoulder. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:139-146. [PMID: 31821298 PMCID: PMC7233701 DOI: 10.23750/abm.v90i12-s.8972] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 11/23/2022]
Abstract
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.
Collapse
|
21
|
Prasathaporn N, Laohathaimongkol T, Umprai V, Kuptniratsaikul V. Arthroscopically Assisted Reduction in a Chronic Locked Posterior Shoulder Dislocation. Arthrosc Tech 2019; 8:e769-e774. [PMID: 31485405 PMCID: PMC6714613 DOI: 10.1016/j.eats.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/13/2019] [Indexed: 02/03/2023] Open
Abstract
Neglected posterior shoulder dislocation is a difficult condition in terms of decision making and surgical technique. Not only the bony deformity but also the soft tissue and patient's underlying disease are of concern. Whether the poor results are associated with a time delay or the treatment method is not clear yet. To date, there is neither a consensus nor treatment guidelines. We describe an arthroscopically assisted reduction and open McLaughlin procedure. The advantage of this procedure is preservation of the soft tissue of the anterior part of the shoulder during the surgical reduction technique for chronic neglected posterior shoulder dislocation cases.
Collapse
Affiliation(s)
| | | | | | - Vanasiri Kuptniratsaikul
- Address correspondence to Vanasiri Kuptniratsaikul, M.D., Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, 290 Jermjomphol Rd, Sriracha Province, Chonburi, Thailand.
| |
Collapse
|
22
|
Seizure-induced shoulder dislocations - Case series and review of the literature. Seizure 2019; 70:38-42. [PMID: 31252362 DOI: 10.1016/j.seizure.2019.06.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 11/22/2022] Open
Abstract
PURPOSE We aimed to identify clinical characteristics of patients with shoulder dislocations caused by an epileptic seizure. METHODS In our retrospective analysis, we identified 15 patients, recorded over an 8-year period, who were diagnosed with shoulder dislocations in the setting of a bilateral tonic-clonic seizure. RESULTS Patients were almost exclusively male (13/15) and drug-naïve patients suffering their first or second seizure (14/15). Epilepsy was diagnosed in five of these 14 patients after further diagnostic tests, four patients were diagnosed with a provoked or acute symptomatic seizure and five patients with an unprovoked seizure. Treatment with anticonvulsant drugs (AED) was initiated in 10/15 patients after the first seizure, without recommendation for tapering, although long-term treatment was retrospectively judged to be appropriate for only four of those cases. Posterior dislocations - usually rare - were seen in 12/15 patients and often required complex orthopedic interventions. CONCLUSIONS We conclude that in particular posterior shoulder dislocations are often caused by a first seizure and should always raise the suspicion of an epileptic seizure even in the absence of a clear history. AED treatment likely has a protective effect against this type of injury, even if seizure-freedom is not achieved.
Collapse
|