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Diagnostic standards and concepts for treatment of missed and unreduced posterior shoulder dislocations
$36
82
J. Shoulder Elbow Surg. March/April 1996
Abstracts
THE MANAGEMENT OF LOCKED TRAUMATIC POSTERIOR SHOULDER DISLOCATIONS. A L Armstrong, S P Frostick, W A Wallace. Dept Orthopaedics, Univ Hesp, Nottingham. UK.
84
To review and evaluate the management of locked traumatic posterior shoulder dislocations in a specialised shoulder practice. Over five years, 20 patients with 24 posterior dislocations have been managed in our centre. The mean age at injury was 55 years (range 35 to 83 years). The reason for the dislocations were an epileptic fit (7), a road traffic accident (4), an electric shock (3), a fall (4) and other (2). Thirteen of the 24 were diagnosed early (within 3 days of injury), 8 of the 24 were diagnosed late (3d to 9 rap) and 3 of the 24 were diagnosed very late (9 mo to 12 y). Manipulation under anaesthesia (MUA) alone with no further surgery was successfu} in 7 of the i0 cases diagnosed early. MUA was attempted in 5 of the 8 late cases and was successful in only one. In patients referred to our unit irrespective of the time to treatment, shoulder replacement was the primary treatment for dislocations which were:a) associated with 3 and 4 part fractures (3 cases) b) associated with osteoarthritis (1 case) c) with more than 50% loss of the humeral head (4 cases) If none of these were present, then open reduction with or without anterior humeral head reconstruction was suceasful in those cases(3) treated 3 days to 9 months. In thoses cases treated after 9 months (5) the head was irreducible at operation and a humeral arthroplasty was perfbrmed. An anterior approac~ was successfully used for both operations.
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The management of a locked posterior dislocation can be difficult, especially as late diagnosis is not uncommon. This review gives guidelines as to the treatment method whicti is likely to be suecesful, dependent on the time to treatment and the type of posterior dislocation.
83
NEGLECTED POSTERIOR DISLOCATION OF SHOULDER (RESULTS OF OPEN REDUCTION). Sandhu, H.S., Sandhu, P.S., Singh, R. Amritsar, India, Posterior dislocation of the shoulder is an uncommon injury of the shoulder girdle and hence the diagnosis may be missed in initial stages.Sixteen cases of neglected posterior dislocation of the shoulder were treated during the period 1974 to 1993.There were 12 male and 4 female with age ranging from 22 to 33 years with average of 26.5 years. The duration of dislocation was 4 to 24 weeks with average of 9.5 weeks.The presenting symptoms were marked limitation of movements of the shoulder. Pour cases had dull local pain.On clinical examination a globular swelling could be seen and palpated under the acromian. Movements especially abduction and external rotation were markedly restricted. X-ray picture (Axial or Lot.view) revealed posterior displacement of the head of the humerous There was associated fractures of neck of humerus in 2 cases,lesser tubersity in 4 cases .Open reduction was carried out in in all the cases through the anterior Deltopectral approach.Good range of movements were obtained in 14 cases.ln two cas~es the improvement in the range of movements was unsatiss
Diagnostic Standards and Concepts for Treatment of Missed and Unreduced Posterior Shoulder Dislocations M. Loew, M.Thomsen, H M a u . Traumatic posterior shoulder dislocation is a rare and therefore often overlooked injury. Nevertheless during one year 8 patients with missed and unreduced posterior dislocations were admitted to the hospital. Mean duration of the injury until correct diagnosis was 7.5 months (3 - 26 months). The leading clinical sign was a painful limitation of the shoulder movement with stiffness in internal rotation. In all cases the analysis of the primary X-rays in ap - view could show the typical signs of a posterior dislocation: - Enlarged and filled gap between glenoid rim and humeral head; Internal rotation of the humeral head with a characteristic lateral outline. By ultrasound the posterior dislocation could be proved while only in CT-scan the degree o f damage of glenoid and humeral head was visible. The concept for treatment had to respect the extend 02- t, he i n j u r y Only in one case dosed reduction was possible. In two pauents open reduction had to be performed with additional bone graliing to fill up the anterior defect of the humerus. In three patients an osteotomy for external rotation of the humeral head was carried out. In two cases the destruction of the joint was complete and irreversible so that a prosthetic replacement had to be performed. For all patients otter 1 year a satisfactory functional result was reached. X-ray in ap - view and ultrasound can lead to a primary diagnosis of acute posterior shoulder dislocation which is the key for an adequate treatment.
85
APPROACH TO NON-REDUCED POSTERIOR GLENOHUMERAL DISLOCATIONS
Mehmet Demirhan, M.D., ~enol Akman, M.D., Ydmaz Akahn, M.D., Sercan Akpmar, M.D., Mustafa Caniklioglu, M.D. Dept. of Orthopaedics, Univ, of Istanbul, Istanbut Medical Faculty, Turkey & Istanbul SSK Hospital, Turkey Posterior dislocations cover only two percent of all glenohumeral dislocations. The patient presents with an adduction-internal rotation-flexion deformity of his shoulder after a traumatic incident. Routine shoulder radiograms, anteropostedor and oblique, often miss this specific lesion and we need additional axillar and transthoracal views to verify the posterior dislocation. Usually, an anteromedial humeral head impression fracture accompanies this lesion. The type of treatment depends on the period between the trauma and the diagnosis, and the size of the impression fracture. Four cases of posterior glenohumeral dislocations was operated at the Department of Orthopaedics and Traumatology, Istanbul Medical Faculty, University of Istanbul between the years of 1999 and 1994. A shoulder total endoprothesis was performed on a patient with an impression fracture over fifty percent. Two patients was treated with modified Mc Laughlin operation( Neer modification) in which lesser tuberculum had been transferred onto the anterior defect of the humeral head. The last patient had an open reduction wtth posterior capsular shifting. We did not see any recurrence during the postoperative follow-up period ( average four years). According to the Constant scoring system, the patients had an average value of seventy-fiVe points. Our aim ~ this presentation is to discuss various operative methods in the treatment of posterior glenohumeral dislocations in the light of our exper{ence.
82
J. Shoulder Elbow Surg. March/April 1996
Abstracts
THE MANAGEMENT OF LOCKED TRAUMATIC POSTERIOR SHOULDER DISLOCATIONS. A L Armstrong, S P Frostick, W A Wallace. Dept Orthopaedics, Univ Hesp, Nottingham. UK.
84
To review and evaluate the management of locked traumatic posterior shoulder dislocations in a specialised shoulder practice. Over five years, 20 patients with 24 posterior dislocations have been managed in our centre. The mean age at injury was 55 years (range 35 to 83 years). The reason for the dislocations were an epileptic fit (7), a road traffic accident (4), an electric shock (3), a fall (4) and other (2). Thirteen of the 24 were diagnosed early (within 3 days of injury), 8 of the 24 were diagnosed late (3d to 9 rap) and 3 of the 24 were diagnosed very late (9 mo to 12 y). Manipulation under anaesthesia (MUA) alone with no further surgery was successfu} in 7 of the i0 cases diagnosed early. MUA was attempted in 5 of the 8 late cases and was successful in only one. In patients referred to our unit irrespective of the time to treatment, shoulder replacement was the primary treatment for dislocations which were:a) associated with 3 and 4 part fractures (3 cases) b) associated with osteoarthritis (1 case) c) with more than 50% loss of the humeral head (4 cases) If none of these were present, then open reduction with or without anterior humeral head reconstruction was suceasful in those cases(3) treated 3 days to 9 months. In thoses cases treated after 9 months (5) the head was irreducible at operation and a humeral arthroplasty was perfbrmed. An anterior approac~ was successfully used for both operations.
-
The management of a locked posterior dislocation can be difficult, especially as late diagnosis is not uncommon. This review gives guidelines as to the treatment method whicti is likely to be suecesful, dependent on the time to treatment and the type of posterior dislocation.
83
NEGLECTED POSTERIOR DISLOCATION OF SHOULDER (RESULTS OF OPEN REDUCTION). Sandhu, H.S., Sandhu, P.S., Singh, R. Amritsar, India, Posterior dislocation of the shoulder is an uncommon injury of the shoulder girdle and hence the diagnosis may be missed in initial stages.Sixteen cases of neglected posterior dislocation of the shoulder were treated during the period 1974 to 1993.There were 12 male and 4 female with age ranging from 22 to 33 years with average of 26.5 years. The duration of dislocation was 4 to 24 weeks with average of 9.5 weeks.The presenting symptoms were marked limitation of movements of the shoulder. Pour cases had dull local pain.On clinical examination a globular swelling could be seen and palpated under the acromian. Movements especially abduction and external rotation were markedly restricted. X-ray picture (Axial or Lot.view) revealed posterior displacement of the head of the humerous There was associated fractures of neck of humerus in 2 cases,lesser tubersity in 4 cases .Open reduction was carried out in in all the cases through the anterior Deltopectral approach.Good range of movements were obtained in 14 cases.ln two cas~es the improvement in the range of movements was unsatiss
Diagnostic Standards and Concepts for Treatment of Missed and Unreduced Posterior Shoulder Dislocations M. Loew, M.Thomsen, H M a u . Traumatic posterior shoulder dislocation is a rare and therefore often overlooked injury. Nevertheless during one year 8 patients with missed and unreduced posterior dislocations were admitted to the hospital. Mean duration of the injury until correct diagnosis was 7.5 months (3 - 26 months). The leading clinical sign was a painful limitation of the shoulder movement with stiffness in internal rotation. In all cases the analysis of the primary X-rays in ap - view could show the typical signs of a posterior dislocation: - Enlarged and filled gap between glenoid rim and humeral head; Internal rotation of the humeral head with a characteristic lateral outline. By ultrasound the posterior dislocation could be proved while only in CT-scan the degree o f damage of glenoid and humeral head was visible. The concept for treatment had to respect the extend 02- t, he i n j u r y Only in one case dosed reduction was possible. In two pauents open reduction had to be performed with additional bone graliing to fill up the anterior defect of the humerus. In three patients an osteotomy for external rotation of the humeral head was carried out. In two cases the destruction of the joint was complete and irreversible so that a prosthetic replacement had to be performed. For all patients otter 1 year a satisfactory functional result was reached. X-ray in ap - view and ultrasound can lead to a primary diagnosis of acute posterior shoulder dislocation which is the key for an adequate treatment.
85
APPROACH TO NON-REDUCED POSTERIOR GLENOHUMERAL DISLOCATIONS
Mehmet Demirhan, M.D., ~enol Akman, M.D., Ydmaz Akahn, M.D., Sercan Akpmar, M.D., Mustafa Caniklioglu, M.D. Dept. of Orthopaedics, Univ, of Istanbul, Istanbut Medical Faculty, Turkey & Istanbul SSK Hospital, Turkey Posterior dislocations cover only two percent of all glenohumeral dislocations. The patient presents with an adduction-internal rotation-flexion deformity of his shoulder after a traumatic incident. Routine shoulder radiograms, anteropostedor and oblique, often miss this specific lesion and we need additional axillar and transthoracal views to verify the posterior dislocation. Usually, an anteromedial humeral head impression fracture accompanies this lesion. The type of treatment depends on the period between the trauma and the diagnosis, and the size of the impression fracture. Four cases of posterior glenohumeral dislocations was operated at the Department of Orthopaedics and Traumatology, Istanbul Medical Faculty, University of Istanbul between the years of 1999 and 1994. A shoulder total endoprothesis was performed on a patient with an impression fracture over fifty percent. Two patients was treated with modified Mc Laughlin operation( Neer modification) in which lesser tuberculum had been transferred onto the anterior defect of the humeral head. The last patient had an open reduction wtth posterior capsular shifting. We did not see any recurrence during the postoperative follow-up period ( average four years). According to the Constant scoring system, the patients had an average value of seventy-fiVe points. Our aim ~ this presentation is to discuss various operative methods in the treatment of posterior glenohumeral dislocations in the light of our exper{ence.