[Erect dislocation; case report on a bilateral dislocation].
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We present a rare case of fracture-dislocation of shoulder with intrathoracic displacement of the humeral head. This case is well documented by CT. The mechanism and treatment modalities are discussed, and pertinent literature is reviewed.
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Failure of manipulative reduction of acute anterior dislocation of the shoulder is extremely rare. A 55-year-old man dislocated his right shoulder when he fell heavily. Initial radiographs and computed tomographs demonstrated an anterior dislocation with fracture of the glenoid rim. Several attempts at closed reduction were unsuccessful. At the time of open reduction, the cause of failure was found to be interposition of a fragment of the anterior inferior glenoid rim in the joint. To prevent redislocation, the fragment was held in place by two Herbert mini bone screws after anatomic reduction, and the ruptured subscapularis was reattached to the lesser tuberosity. Two and a half months after surgery, the shoulder was stable with full range of motion. To the best of our knowledge, this is the first reported case of interposition of a fracture-fragment of the anterior inferior glenoid rim causing failure of reduction.
Injuries after an electric shock, such as dermal burns, motor and sensory nerve deficits, fractures and dislocations, are reported in the literature. Posterior dislocation of the shoulder after electric-shock is the common musculoskeletal injury. Bilateral dislocation, either anterior or posterior, is rarely seen and reported. We report a case of bilateral shoulder fracture dislocation in opposite directions following an electric-shock and discuss the mechanism, the diagnosis and the treatment.
Seventeen out of eighteen patients, who underwent the modified Bristow operation for anterior recurrent dislocation of the shoulder, were followed up after a mean observation time of 52 months. Fourteen patients were satisfied with the result. There were no redislocations. The principal limitation in range of motion was loss of some external rotation. Eight patients had non-union between the bone transplant and the glenoid rim, and four of these had complications related to the screw. Two had loosenings and two had fractures of the screw. Non-union without screw complications appeared not to influence the end result. The reasons for the complications seem to be technical problems concerning fixation and bone union of the coracoid process.
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Subjective shoulder function, range of motion, isokinetic muscular performance, and radiographs were analyzed in 44 patients at an average follow-up time of 6 years after a Bristow-Latarjet procedure for recurrent dislocations of the shoulder. The injured shoulder was compared with the healthy side in each patient. Ninety-five percent of the patients considered mobility, strength, and stability of the operated shoulder as good or excellent. Totally, 32 of 44 patients (72%) had no pain or discomfort at all, while the remaining 12 (28%) complained of moderate exertional pain. Range of motion in extension, flexion, abduction, and internal and external rotation did not differ significantly between the injured and healthy sides. Nor did isokinetic peak torque at 30 and 90 deg/sec differ in extension, flexion, or internal and external rotation. The rate of healing of the implant did not seem to influence the functional outcome of surgery. Two patients suffered from recurrent dislocations. The Bristow-Latarjet procedure provided a good or excellent long-term functional result in patients with recurrent shoulder dislocations.
Twenty-five shoulders with recurrent instability and associated anterior glenoid rim lesions were reviewed to 1) develop a classification system of the lesions, 2) evaluate radiographic techniques in detecting the lesions, and 3) analyze the outcome of surgery. Lesions were classified into three types: Type I, a displaced avulsion fracture with attached capsule; Type II, a medially displaced fragment malunited to the glenoid rim; and Type III, erosion of the glenoid rim with less than 25% (Type IIIA) or greater than 25% (Type IIIB) deficiency. Lesions were detected by plain radiographs (19 shoulders) or supplemental CT-arthrograms (12 shoulders) or both. In 16 Type I fractures, both the bony fragment and capsule were reattached to the glenoid rim. In five Type II and three Type IIIA lesions, only the capsule was repaired to the remaining glenoid rim. In the one Type IIIB lesion, a coracoid transfer was performed. At an average followup of 30 months, 22 shoulders (88%) had satisfactory results without recurrent instability, whereas three shoulders (12%) had postoperative redislocations. The majority of recurrent anterior dislocations with associated glenoid rim lesions can be treated by suturing the fracture fragment or capsule or both to the glenoid rim and addressing associated capsular laxity.
A case of longitudinal tearing of the axillary artery is reported following anterior dislocation of the shoulder in an 87-year old woman, resulting in fatal haemorrhage. Atherosclerosis of the axillary artery and a history of previous dislocation of the affected shoulder were predisposing factors.
A review of 107 cases in which the Bristow-Helfet procedure was done for recurrent anterior shoulder subluxation and dislocation is presented. The redislocation rate was 2% with very few complications. Eighty-nine percent of the patients were satisfied with the procedure. Mean loss of external rotation was 12.6 degrees. Six of the 41 patients with dominant shoulder surgery were capable of throwing in the same manner as they did prior to injury. Five of 24 patients (21%) with a diagnosis of recurrent anterior subluxation continued to have symptoms of instability following surgery. Associated symptoms of posterior or voluntary subluxation may preclude a satisfactory result.
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