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PubMed2006

Dislocation of the shoulder joint with ipsilateral humeral shaft fracture: two case reports.

INTRODUCTION: A combination of the shaft fracture of the humerus with shoulder dislocation is a rarely documented injury. Moreover, few reports describe a long-term outcome after a follow-up period over 10 years. The present article is the first report of long-term clinical results obtained with this combined injury. MATERIALS AND METHODS: We present two cases of the dislocation of the shoulder joint with ipsilateral humeral shaft fracture. One is an anterior dislocation and the other is posterior. The anterior dislocation was closely reduced on the date of injury, but the posterior dislocation required open reduction 6 weeks after the injury because it was missed at the initial diagnosis and identified 4 weeks after the injury. In the latter case, shoulder pain and limitation of the motion persisting after the first surgery had to be treated by anterior acromioplasty and arthrolysis of the shoulder. In both cases, the humeral fracture was fixed by retrograde intramedullary nailing using a Küntscher nail and successful bone union was achieved. RESULTS: At over 10-year follow-up examination, both patients had no limitation in activities of daily living and no restrictions to their normal occupation. The radiographs of the shoulder joint demonstrated good clinical results, with no degenerative change or osteonecrosis. CONCLUSION: We have experienced two cases of dislocation of the shoulder joint with ipsilateral humeral shaft fracture and reported long-term results over 10 years. Good clinical results were demonstrated in both cases.

Accidents, Traffic↗
PubMed1983

Voluntary anterior dislocation of the shoulder: case study.

Anterior shoulder dislocation can be willfully produced by a subject through abnormal unbalanced muscle contraction at the shoulder joint. It may be associated with pathologic lesions at the shoulder. Treatment consists of vigorous shoulder strengthening exercises and/or surgery to increase anterior stability at the joint. For any treatment approach to be successful the subject must avoid dislocation of the shoulder. A psychologic component frequently associated with this condition is its use as a mechanism for attention, sympathy or defense--a factor that has a significant negative effect on response to treatment.

Adult↗
PubMed1992

[Dislocation fractures of the shoulder. Special status and therapeutic concepts].

Shoulder dislocations associated with a displaced fracture of the humeral head or glenoid require different treatment than shoulder dislocations without fracture. If the humeral head is fractured, two possible complications must be considered:impairment of the subacromial gliding mechanism and insufficient blood supply to the humeral head. In glenoid fractures, instability may be induced. The degree of instability depends on the size of the fragment. In fractures of the humeral head, in particular of the greater tuberosity, we differentiate between the so-called en bloc fracture and the so-called supra-spinatus avulsion fracture. In "en bloc" fractures, one has to be aware that displacement of the fragment can occur not only in the superior direction but in the posterior direction as well. Posterior displacement is displayed radiologically by the "tangential" view. Both the duration of pain and range of motion depend on the amount of displacement of the fragment. Displacement exceeding 3 min in one direction should be reduced surgically in the active patient. For operative treatment of a displaced "en bloc" fracture, we recommend closed reduction and percutaneous screw fixation performed under regional anesthesia. "Supraspinatus avulsion fractures" ought to be treated like rotator cuff tears because there is no possibility of the small fragments healing due to their placement on the joint cartilage. In fracture dislocations, the blood supply of the humeral head is seriously jeopardized if the fracture is situated in the anatomical neck, whereas this is not the case in a fracture of the surgical neck. The number of displaced fragments allows a prediction concerning the survival of the articular segment of the humeral head.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

One hundred eighteen Bristow-Latarjet repairs for recurrent anterior dislocation of the shoulder prospectively followed for fifteen years: study I--clinical results.

In this prospective study on the Bristow-Latarjet repair, which started in 1980 and ended in 2001, we report the outcome in 118 shoulders where the patients have been followed up for 15 years (mean, 15.2 years; range, 14.3-20.8 years). The study was based on a physical examination, scoring with the system of Rowe et al, and the patients' subjective assessment of the operative result. After 2 years, 1 of 118 shoulders had redislocated and 98% of patients were satisfied with the operative repair. At 15 years' follow-up, 1 patient had undergone revision surgery as a result of recurrence of instability. One patient had had one redislocation during the follow-up period, and one patient reported three recurrences 3 years postoperatively. This patient has had no redislocations during the last 12 years. Furthermore, one more patient had had two recurrences 9 and 12 years after surgery but was very satisfied at follow-up. Subluxations occurred once in 4 patients and several times in 7 patients. These patients were, however, satisfied with the procedures at follow-up. One patient reported posterior subluxations at follow-up. Apprehension was significantly more common in patients with bilateral instability (P =.04) and was found in 19 of 109 shoulders. Of the patients, 90 (76%) were very satisfied with the operative result, 26 were satisfied (22%), and 1 did not know. The patient with revision surgery was considered to be dissatisfied. The incidence of bilateral shoulder instability increased from 22 of 118 (19%) at the time of surgery to 41 of 117 (35%) at 15 years after surgery. We conclude that the overall clinical results, with a satisfaction rate of 98% 15 years after the Bristow-Latarjet repair, were as good as the results reported after any operative method for recurrent anterior shoulder dislocation. However, until the radiologic part of this study is completed, we recommend the procedure only for shoulders with revision because of failed previous surgery and to surgeons familiar with the method.

Adult↗
PubMed1989

Anterior dislocation of the shoulders with bilateral brachial plexus injury.

A case of bilateral anterior shoulder dislocation accompanied by bilateral brachial plexus injuries is presented. A 53-year-old man fell and landed on his chest and arms flexed at the elbows. The dislocations were satisfactorily reduced using the forward elevation, flexion maneuver. Electromyography and nerve conduction studies confirmed bilateral brachial plexus lesions. Arthrogram of the right shoulder demonstrated a rotator cuff tear. The patient is undergoing physical therapy and making a slow recovery.

Brachial Plexus↗
PubMed1983

Adolescent traumatic dislocations of the shoulder with open epiphyses.

Nine of 212 cases of traumatic anterior shoulder dislocations occurred in children with clearly open epiphyses (4.7% incidence). All cases associated with psychological or physical abnormalities were excluded. A high recurrence rate of 80% (8 of 10) was noted requiring operative intervention. Two of the three remaining unoperated cases had a history of "subluxation" after their initial dislocation.

Adolescent↗
PubMed1983

Axillary artery disruption secondary to anterior dislocation of the shoulder.

We report a 13-year-old male who sustained a segmental injury to the third part of the left axillary artery following a subcoracoid shoulder dislocation while wrestling. The artery was repaired with an autogenous saphenous vein interposition graft. The patient's postoperative course was uneventful, and, in a 3-year followup, he has complete range of motion of the left shoulder without neurovascular compromise.

Adolescent↗
PubMed2005

First-time traumatic anterior dislocation of the shoulder in young adults: the position of the arm during immobilisation revisited.

In contrast to the surgical treatment of chronic shoulder instability, there are only scarce publications about the management after a first episode of anterior shoulder dislocation and how to prevent the evolution towards chronic instability. We present here a review of the literature on this subject. Particular attention is paid to recent studies about the position of the arm during immobilisation. According to recent views, it may be preferable to immobilise the arm in external rather than internal rotation, but this has to be confirmed by further clinical studies. The issue of early arthroscopic stabilisation after a first dislocation event in young athletic patients is also discussed.

Adult↗
PubMedDate not supplied

Should acute anterior dislocations of the shoulder be immobilized in external rotation? A cadaveric study.

The high recurrence rate associated with anterior shoulder dislocations may reflect inadequate healing of a Bankart lesion when the arm is immobilized in internal rotation. The effect of external rotation (ER) of the humerus on the glenoid-labrum contact of Bankart lesions was examined in 10 human cadaveric shoulders. The contact force between the glenoid labrum and the glenoid was measured in 60 degrees of internal rotation, neutral rotation, and 45 degrees of ER in 10 human cadaveric shoulders. No detectable contact force was found with the arm in internal rotation. The contact force increased as the arm passed through neutral rotation and reached a maximum at 45 degrees of ER. The contact force returned to 0 g when the arm was returned to neutral rotation. The mean contact force at 45 degrees of ER was 83.5 g. External rotation significantly increases the labrum-glenoid contact force and may influence the healing of a Bankart lesion.

Acute Disease↗
PubMed2003

Satisfactory long-term results after Eden-Hybbinette-Alvik operation for recurrent anterior dislocation of the shoulder: 6-20 years' follow-up of 52 patients.

We studied the outcome after the Eden-Hybbinette-Alvik operation for recurrent anterior shoulder dislocation in 52 patients after a mean of 14 (6-20) years. Their mean age at operation was 26 years. Redislocation occurred in 2/52 patients. The success rate was 49/52, when rated by the patients, and 38/45, using the Carter-Rowe shoulder score. 44/52 reported no pain, 48/52 no limitations at work and 37/51 no limitations in sports. Mild and moderate arthrosis were found in 24/45 on the operated side and 9/45 on the uninvolved side. None (0/21) of the patients without arthrosis and 5/24 of those with arthrosis in the operated shoulder reported mild or moderate pain.

Adolescent↗
PubMed2001

[Current treatment concepts in first-time dislocation of the shoulder joint].

The rapid development of arthroscopic techniques has raised questions on the treatment of first shoulder dislocations. Primary arthroscopic or even open labral repair have been recommended. However, the available prospective studies demonstrate a recurrence rate of not more than 50% in the global population. This number increases steeply if certain risk factors are present: young age (under 25 years), shoulder sports, adequate trauma with acute unidirectional instability. For this selected group, arthroscopic labral repair should be proposed and should be performed by a surgeon specifically trained in this advanced arthroscopic technique. Repair of the labrum is feasible with various arthroscopic techniques, whereas the shortening of redundant capsular areas still poses problems. The efficiency of laser- or heat-shrinking of the shoulder capsule must yet be proven.

Adolescent↗
PubMed1996

A prospective controlled randomized study of arthroscopic lavage in acute primary anterior dislocation of the shoulder: one-year follow-up.

Traumatic primary anterior shoulder dislocation has a very high recurrence rate among young people. This has supplied the motivation for studies to find methods of treatment that might become an alternative to traditional therapy. A prospective controlled study was performed to test the hypothesis that acute arthroscopic lavage might have a positive effect on recurrence rate as well as on shoulder stability, range of motion and mobilization. 30 consecutive patients between 18 and 30 years of age were randomized into 2 groups, 1 control group treated conservatively and 1 group treated with acute arthroscopic lavage within 10 days. Clinical examination was made by an independent observer at 1, 6 and 12 months. Results at 6- and 12-month check-ups showed a statistically significantly lower rate of redislocation and a wider range of motion for the group treated with acute arthroscopic lavage. Functional assessment according to the Lysholm shoulder score also indicated better functioning of the joint. Our 1-year follow-up shows very promising and interesting results.

Adult↗
PubMed1984

Neuropraxis secondary to hemorrhage in a traumatic dislocation of the shoulder.

A case of traumatic shoulder dislocation associated with a tear of the subscapular artery is presented. The main clinical feature was a dramatic neurologic loss of the brachial plexus, reversed by exploration, evacuation of hematoma, and ligation of the bleeding vessel. Early surgical decompression to achieve neurologic recovery is emphasized.

Aged↗
PubMedDate not supplied

Capsuloplasty for the treatment of recurrent anterior dislocation of the shoulder: long-term evaluations of the Putti-Platt method and Bankart method with anchors.

The authors compare two methods used for the treatment of recurrent anterior shoulder dislocations: Putti-Platt capsulomyoplasty, based on an overlapping suture of the free margins of the joint capsule and of the subscapularis muscle, and the Bankart method that uses anchors, based on the repair of the glenoid labrum, that is kept in site, together with the medial flap of the joint capsule, by suturing with the anchors previously stabilized to the neck of the glena. In this method, the subscapularis muscle is re-approximated without any overlapping or shortening. The Bankart method with anchors thus allows us to obtain anatomical repair of the lesion, with doubtless advantages for mobility, function and stability of the shoulder; this is confirmed by the comparison with results obtained out of 34 patients in this study, 15 of which submitted to the Putti-Platt method, 19 to the Bankart method with anchors. The latter had reduction of external rotation which in none of the cases exceeded 25% (a reduction that at times achieved 50% in patients submitted to the Putti-Platt method (p = 0.001); difficulties in work or sports were minimum or absent (p = 0.003), recovery time was more rapid, without compromising joint stability (p = 0.069); these data allow us to consider the Bankart method with anchors the surgical method that is most indicated for the treatment of anterior glenohumeral instability.

Adolescent↗