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Results of a modified bristow procedure for recurrent anterior dislocation of the shoulder
Abstracts
J. Shoulder Elbow Surg. Volume 4, Number 1, Part 2
RESULTS OF A MODIFIED BRISTOW PROCEDURE FOR RECURRENT ANTERIOR DISLOCATION OF THE SHOULDER Department of Orthopaedic Surgery, Okayama University Medical School Hiroyuki Hashizume, Yoshihumi Nanba, Haiime Inoue Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital Kazuho Yoshimura, Kenichi Ogawa We reqmwed the results of treatment for recurrent anterior dislocation of the shoulder to assess the appropriateness of a modified Bristow procedure. Twenty-two patients who were surgically treated between 1986 and 1993 were available for follow-up examinations (average 40 months). The 15 male and 7 female patients averaged 6 dislocations before surgery (13 right and 9 left shoulders). The average period between initial dislocation and surgery was 50 months. The original Bristow procedure was modified by reattaching a longer coracoid process at a more lateral site, almost even with the glenoid rim which allows treatment of cases with bony defects in the anterior region. The pre- and post-surgical conditions of the shoulders were scored with the 7. O. A. system. The average pre-surgical score was 79.5 points, and the average post-surgical score was 94.5 points. Residual restriction of external rotation reduced the post- surgical score. The apprehension test was negative for all patients. Post-surgical redislocation, subluxation, and muscle weakness were absent. Neither nerve paralysis nor vascular injury were observed. The only complication was a screw that migrated. Almost all patients returned to their original sports and occupations. The modified procedure was found to be effective in the cases with a bony defect on the anterior part of the glenoid rim.
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Comparative studies between conservative and operative t r e a t m e n t s for massive r o t a t o r cuff t e a r s N. Yamada, M.D., K. Hamada, M. D., T. Nakajima, M. D., and H. Fukuda, M. D. Dept. of Orthopaedic Surgery, Tokai University, /Isehara, Japan This s t u d y was done t o evaluate the r e s u l t s of conservative and operative t r e a t m e n t s for massive r o t a t o r cuff t e a r s . Ten patients, 7 men and 3 women of the m e a n age of 71, were t r e a t e d conservatively and followed up for 3.7 years on the a v e r a g e ( G r o u p I). These p a t i e n t s were of Grade 4 a r t h r o g r a m of H a m a d a ' s a r t h r o g r a p h i c classification. Twenty patients, 17 men and 3 women, comprised the operative g r o u p who had cuff t e a r s of more t h a n 5.0 cm in the longest d i m e n s i o n ( G r o u p II). The mean age at o p e r a t i o n w a s 63 years. A n t e r i o r a c r o m i o p l a s t y was performed in all cases. The additional procedures were t e n o r r h a p h y ( t e n d o n t o bone)in 14, fascia g r a f t in 4 and B u s h ' s p r o c e d u r e in 2. The mean follow up period w a s 3.1 years. The r e s u l t s were a s s e s s e d by t h e JOA score. The JOA score in G r o u p I increased f r o m 52.9 t o 71.7, while in G r o u p Ii from preoperative 50.1 to 85.3. More pain relief, muscle s t r e n g t h and r a n g e of m o t i o n were obtained in G r o u p II t h a n in G r o u p I. There was a s~atistically significant difference between r u p t u r e d and n o n - r u p t u r e d l o n g head of biceps.
19
$71
T h r e e Dimensional Analysis of Glenoid and GlenoHumeral Joint in Habitual Posterior Dislocation of the Shoulder Department of Orthopaedic S urgery,Toky o Medical and Dental University M.Tanaka, T.Nakagaw a, M.Ishizuki, K.Mimori, H .S amejima, K .Furuy a, A.Ish ida The purp ose of this study is to analy sis the three dimensional movement of the glenoid and the glenohumeral joint in the habitual posterior dislocation of the shoulder. 5 male and 6 female patients of habitual posterior dis location w ere examined. The magnetic sensor sy stem was used as the measuring equipment. The magneticfield generating source was fixed to the sternum, and sensors were fixed to the lateral ep icondyle of the humerus and to the spina scapulae. Elevation was measured in sagittal plane,scapular plane,and frontal plane. The elev ation time was 5 seconds. The gleno-humeral joint with inferior instability was a decrease in the elevation angle at the initial stage of rnov ement. The glenoid in sagittaloPlane didn't face the plane of flexion during initial 90 Incoordination of the scapula and the humerus was one of causes of the posterior shoulder instability.
20
RESULTS OF SURGICAL TREATMENT FOR MASSIVE ROTATOR CUFF TEARS. M.Kamihira,MD,T.Kutsuma,MD, T. Tsuchiya ,MD,Dept. of Orhop. Surg., Kofu City Hospital, Japan Forty-three shoulders with massive rotator cuff tears were operated on during the 22 years since 1972. We reviewed the 29 of these .cases ( 20 males, 9 females, age range 47 ~ 7 6 years, mean : 62 years) which could not be repaired by McLaughlin's procedure. The postoperative follow-up period ranged from i year to 19 years ( mean: 101 months ). The surgical procedures were as follows: Debeyre's procedure, 12 cases; deltoid-rotator cuff suture, 6 cases; trapezius transfer, 8 cases; tuberculum majus transfer, 3 cases. The results were evaluated by JOA score. We obtained the following results. (1) supraspinatus advancement(Debeyre): excellent 4, good 7, fair 1. This procedure was applied to the cases in which the cuff edges could only be pulled out a little bit and could not be reinserted into the humeral head. (2) deltoid-rotator cuff suture: excellent 2, good 2, fair 1, poor 1. Sufficient abductor strength could not be obtained in such patients with severe deltoid atrophy. (3) trapezius transfer: excellent 2, good 4, fair 2. This procedure was used in cases of global tears in which the tendinous portion could not be detected in the cuff edges and the humeral head was completely exposed. (4) tuberculum majus transfer: excellent 1, good 2. In order to obtain satisfactory results in the surgical treatment of massive rotator cuff tears, it is important to select repair procedures according to the condition of the edges of the torn cuff.
J. Shoulder Elbow Surg. Volume 4, Number 1, Part 2
RESULTS OF A MODIFIED BRISTOW PROCEDURE FOR RECURRENT ANTERIOR DISLOCATION OF THE SHOULDER Department of Orthopaedic Surgery, Okayama University Medical School Hiroyuki Hashizume, Yoshihumi Nanba, Haiime Inoue Department of Orthopaedic Surgery, Okayama Saiseikai General Hospital Kazuho Yoshimura, Kenichi Ogawa We reqmwed the results of treatment for recurrent anterior dislocation of the shoulder to assess the appropriateness of a modified Bristow procedure. Twenty-two patients who were surgically treated between 1986 and 1993 were available for follow-up examinations (average 40 months). The 15 male and 7 female patients averaged 6 dislocations before surgery (13 right and 9 left shoulders). The average period between initial dislocation and surgery was 50 months. The original Bristow procedure was modified by reattaching a longer coracoid process at a more lateral site, almost even with the glenoid rim which allows treatment of cases with bony defects in the anterior region. The pre- and post-surgical conditions of the shoulders were scored with the 7. O. A. system. The average pre-surgical score was 79.5 points, and the average post-surgical score was 94.5 points. Residual restriction of external rotation reduced the post- surgical score. The apprehension test was negative for all patients. Post-surgical redislocation, subluxation, and muscle weakness were absent. Neither nerve paralysis nor vascular injury were observed. The only complication was a screw that migrated. Almost all patients returned to their original sports and occupations. The modified procedure was found to be effective in the cases with a bony defect on the anterior part of the glenoid rim.
18
Comparative studies between conservative and operative t r e a t m e n t s for massive r o t a t o r cuff t e a r s N. Yamada, M.D., K. Hamada, M. D., T. Nakajima, M. D., and H. Fukuda, M. D. Dept. of Orthopaedic Surgery, Tokai University, /Isehara, Japan This s t u d y was done t o evaluate the r e s u l t s of conservative and operative t r e a t m e n t s for massive r o t a t o r cuff t e a r s . Ten patients, 7 men and 3 women of the m e a n age of 71, were t r e a t e d conservatively and followed up for 3.7 years on the a v e r a g e ( G r o u p I). These p a t i e n t s were of Grade 4 a r t h r o g r a m of H a m a d a ' s a r t h r o g r a p h i c classification. Twenty patients, 17 men and 3 women, comprised the operative g r o u p who had cuff t e a r s of more t h a n 5.0 cm in the longest d i m e n s i o n ( G r o u p II). The mean age at o p e r a t i o n w a s 63 years. A n t e r i o r a c r o m i o p l a s t y was performed in all cases. The additional procedures were t e n o r r h a p h y ( t e n d o n t o bone)in 14, fascia g r a f t in 4 and B u s h ' s p r o c e d u r e in 2. The mean follow up period w a s 3.1 years. The r e s u l t s were a s s e s s e d by t h e JOA score. The JOA score in G r o u p I increased f r o m 52.9 t o 71.7, while in G r o u p Ii from preoperative 50.1 to 85.3. More pain relief, muscle s t r e n g t h and r a n g e of m o t i o n were obtained in G r o u p II t h a n in G r o u p I. There was a s~atistically significant difference between r u p t u r e d and n o n - r u p t u r e d l o n g head of biceps.
19
$71
T h r e e Dimensional Analysis of Glenoid and GlenoHumeral Joint in Habitual Posterior Dislocation of the Shoulder Department of Orthopaedic S urgery,Toky o Medical and Dental University M.Tanaka, T.Nakagaw a, M.Ishizuki, K.Mimori, H .S amejima, K .Furuy a, A.Ish ida The purp ose of this study is to analy sis the three dimensional movement of the glenoid and the glenohumeral joint in the habitual posterior dislocation of the shoulder. 5 male and 6 female patients of habitual posterior dis location w ere examined. The magnetic sensor sy stem was used as the measuring equipment. The magneticfield generating source was fixed to the sternum, and sensors were fixed to the lateral ep icondyle of the humerus and to the spina scapulae. Elevation was measured in sagittal plane,scapular plane,and frontal plane. The elev ation time was 5 seconds. The gleno-humeral joint with inferior instability was a decrease in the elevation angle at the initial stage of rnov ement. The glenoid in sagittaloPlane didn't face the plane of flexion during initial 90 Incoordination of the scapula and the humerus was one of causes of the posterior shoulder instability.
20
RESULTS OF SURGICAL TREATMENT FOR MASSIVE ROTATOR CUFF TEARS. M.Kamihira,MD,T.Kutsuma,MD, T. Tsuchiya ,MD,Dept. of Orhop. Surg., Kofu City Hospital, Japan Forty-three shoulders with massive rotator cuff tears were operated on during the 22 years since 1972. We reviewed the 29 of these .cases ( 20 males, 9 females, age range 47 ~ 7 6 years, mean : 62 years) which could not be repaired by McLaughlin's procedure. The postoperative follow-up period ranged from i year to 19 years ( mean: 101 months ). The surgical procedures were as follows: Debeyre's procedure, 12 cases; deltoid-rotator cuff suture, 6 cases; trapezius transfer, 8 cases; tuberculum majus transfer, 3 cases. The results were evaluated by JOA score. We obtained the following results. (1) supraspinatus advancement(Debeyre): excellent 4, good 7, fair 1. This procedure was applied to the cases in which the cuff edges could only be pulled out a little bit and could not be reinserted into the humeral head. (2) deltoid-rotator cuff suture: excellent 2, good 2, fair 1, poor 1. Sufficient abductor strength could not be obtained in such patients with severe deltoid atrophy. (3) trapezius transfer: excellent 2, good 4, fair 2. This procedure was used in cases of global tears in which the tendinous portion could not be detected in the cuff edges and the humeral head was completely exposed. (4) tuberculum majus transfer: excellent 1, good 2. In order to obtain satisfactory results in the surgical treatment of massive rotator cuff tears, it is important to select repair procedures according to the condition of the edges of the torn cuff.