Anterior Dislocation Research Articles

Acetabular revision for iliopsoas impingement: a study of 55 cases at 3 years of follow-up. Does the procedure achieve the Minimal Clinically Important Difference (MCID) in the Oxford-12 score in more than 80% of cases?

IntroductionSeveral surgical options can be offered to manage iliopsoas impingement. Research published on cup replacements often concerns a small population size or multicentre studies, suggesting a variety of indications. We conducted a retrospective single centre study screening according to a specific protocol of a population of patients who had a cup replacement for iliopsoas impingement. The objectives were: 1) to specify the functional outcomes and the achievement of the Minimal Clinically Important Difference (MCID) and the Patient Acceptable Symptom State (PASS) according to the Oxford-12 score, and 2) to assess the complication rate. HypothesisOur hypothesis was that acetabular replacements achieve a Minimal Clinically Important Difference (MCID) in more than 80% of cases. Patients and methodsFifty-five hips underwent acetabular revision between 2011 and 2020. Forty-three were performed as first-line surgery, eight after failed tenotomy and four after failed anterior hip capsule thickening plasty. A CT scan of all the hips revealed a median overhang of 9 mm (7; 12) and a 7 ° cup anteversion (2; 19). Follow-up included assessment of the Oxford-12 score using MCID and PASS, the Merle d'Aubigné score, an assessment of hip flexion muscle strength using the Medical Research Council scale, and an assessment of satisfaction and complications. ResultsAt a mean follow-up of 3 years (2–10), the difference in the Oxford score before and at follow-up was 18 points (15; 27) (p < 0.001), the median Medical Research Council score was 4.5 (4; 5) and patients were satisfied or very satisfied in 73% of cases (40/55). The MCID was achieved for 87% of the hips (48/55), and the PASS was achieved in 67% of cases (33/55). The rate of complications involving surgical revision was 10.9% (6/55) with respectively: two anterior dislocations, one early infection on day 10 resolved after wound irrigation and appropriate antibiotic therapy, one intraoperative fracture of the trochanter requiring osteosynthesis and one arthroscopic revision to remove a free cement fragment. ConclusionDue to a good functional outcome but a high complication rate, a cup replacement can be offered for iliopsoas impingement associated with acetabular malposition or significant overhang. Level of evidenceIV.

Clinical and radiological evaluation of the Bristow–Latarjet procedure in patients with 30 or more years of follow-up

BackgroundThe Bristow-Latarjet surgery is the procedure most performed for recurrent anterior shoulder dislocation. There are few studies with a follow-up of more than 20 years. Because it is a nonanatomical technique, there is interest in knowing the clinical and radiological results and the rates of complications in the long term. MethodsWe performed a retrospective case series study. Patients with recurrent anterior dislocation of the shoulder who underwent the Bristow-Latarjet procedure were included and followed-up clinically for at least 30 years. We evaluated clinical scores - the Rowe, Western Ontario Shoulder Instability (WOSI), Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) – as well as clinical outcomes: the relapse (dislocation or subluxation) and seizure. Screw and graft positioning were assessed by computed tomography (CT), the degree of arthropathy by radiography, and subscapularis fatty degeneration as rotator cuff tears by magnetic resonance imaging (MRI). Both clinical scores and imaging were obtained at 30 years of surgery. ResultsTwenty-seven patients (30 shoulders) were evaluated, with a mean follow-up of 35±4.5 years. The scores obtained were 88.28±15.9 by Rowe, 208±244.2 by the WOSI examination, 92.5%±10.4% by the SANE and 0.45±1.3 by the VAS. The recurrence rate was 13.3%, with all patients presenting subluxations and no new dislocations. All grafts were positioned below the glenoid equator. In 82.4% of the cases, the grafts were aligned with the articular surface, 5.9% were medially deviated, and 11.8% were laterally deviated. Consolidation occurred in 76.5% of the cases. The screws presented bicortical fixation in 76.5% of the shoulders and inclination in the axial plane of less than 15° in 64.7%. A total of 58.8% of the cases presented with glenohumeral arthropathy, and 75% of the MRIs showed the absence of fatty degeneration. ConclusionBristow–Latarjet surgery demonstrates excellent clinical results in most patients after 30 years of follow-up. The recurrence rate is low, as is the complication rate. Glenohumeral arthropathy occurs in most patients without significant clinical repercussions.

Comparison of Modified Latarjet Procedure With Bone Graft Versus Standard Latarjet Procedure: Evaluating Outcomes and Stability.

The Latarjet procedure is a well-established technique for managing repeated anterior shoulder dislocation accompanied by massive glenoid bone loss. Aim of this article was to assess outcomes amongmodified Latarjet procedure using allograft from Iliac bone and a standard Latarjet procedure using the coracoid process. Six patients with recurrent anterior shoulder instability and significant glenoid bone loss were retrospectively analyzed. Three patients underwent the modified Latarjet procedure with iliac crest bone graft (Group A), and three underwent the standard Latarjet procedure (Group B). Outcomes were assessed at the 12-month follow-up, including shoulder stability, functional scores (Constant, the American Shoulder and Elbow Surgeons (ASES) score, and the Western Ontario Shoulder Instability Index (WOSI)), range of motion, complications, and return to sports. Both groups showed improvements in stability and functional scores, with no recurrent instability reported. Group A demonstrated slightly higher functional scores and range of motion. One patient in Group A experienced donor site pain, while one patient in Group B showed significant graft resorption. Graft union was achieved in all patients. Two-thirds of patients in each group returned to their pre-injury level of sports participation. Both techniques provided good clinical outcomes for anterior shoulder instability with glenoid bone loss. The modified Latarjet with iliac crest graft may offer slight advantages in functional outcomes and graft preservation but is associated with potential donor site morbidity. Larger, prospective studies are needed to definitively compare these techniques.

Anterior Sacroiliac Fracture Dislocation: A Comparative Radiologic analysis of Crescent Fractures in Pelvic Ring Injuries: A Retrospective Study.

Background and Objectives: Anterior sacroiliac fracture dislocation (ASFD), also known as locked pelvis, is a rarely reported diagnosis. The types of ASFDs are often misdiagnosed as lateral compression fractures due to the presence of crescent fractures. In this study, we distinguished ASFD from lateral compression fractures (LC 2) and studied their characteristics. Materials and Methods: This is a retrospective study involving patients from a Level 1 trauma center. Fifty-nine patients under the age of 65 years with crescent fractures caused by a high-energy mechanism were investigated. Results: The incidence of ASFD was 25% (15 of 59) in patients with crescent fractures. Among the 15 patients, 6 had override of the ilium over the sacrum, inhibiting reduction in the sacroiliac joint. Pre-operative radiographic evaluations revealed that vertical displacement of the ASFD was larger than that of lateral compression fracture (LC 2) in the outlet view (mean 9.5 vs. 1.9 mm, p = 0.013), and the pelvic asymmetry ratio was larger in ASFD (mean 7.8 vs. 4.1, p = 0.006) in the pelvis AP view. All patients achieved union after surgery. Post-operative radiography showed no significant vertical displacement difference. There was no difference in vascular injury or hemodynamic instability requiring embolization or preperitoneal pelvic packing (PPP) between the two groups. Conclusions: Patients with ASFD have greater vertical displacement and asymmetry compared to patients with LC 2 fractures. These fractures must be distinguished for appropriate reduction and anterior plate fixation.

Treatment concepts for the medial clavicle and the sternoclavicular joint

Medial clavicle fractures and injuries to the sternoclavicular joint are rare injuries but can have life-threatening consequences. There are no standardized treatment algorithms or guidelines for the diagnostics and treatment. This article provides an overview of the individual topographies as well as the conservative and surgical treatment strategies.Conservative treatment is preferred for medial clavicle fractures. The indications for surgical treatment are variable but this is frequently carried out if there is a fracture displacement > 1 cm or1 shaft width and high functional demands. In the case of accompanying injuries to neurovascular structures, an open fracture or the threat of perforation of the skin, surgical treatment is mandatory. Open reduction and internal fixation using (locking) plates is currently the preferred form of treatment.In the case of posterior dislocation of the sternoclavicular joint, an immediate closed reduction must be attempted with the patient under analgosedation and with emergency treatment on standby. This temporal urgency does not exist for anterior and superior dislocations. Surgical treatment is indicated in cases of unsuccessful reduction, persistent symptomatic instability or injuries of the neurovascular bundle. From a multitude of treatment options, arthrodesis with suture cerclage has shown good results. Tendon grafts as well as special hook plates are increasingly being used due to better biomechanical qualities. The surgical treatment of combined injuries is determined by the individual injury pattern.Despite the variety of treatment strategies, the long-term outcome has consistently been positively described.

Comparison of the Latarjet Procedure and Iliac Crest Bone Graft Transfer in Bone Bankart Lesions in Recurrent Anterior Shoulder Dislocations.

There are various treatment modalities for bony Bankart lesions following glenohumeral joint dislocations. In this research, we aimed to compare the radiological and clinical results of patients who underwent the Latarjet procedure and iliac crest bone graft transfer. Clinical and radiological data of 15 patients were retrospectively evaluated. Inclusion criteria were a history of at least two dislocations, being between 18-65 years of age and having at least 10% glenoid bone loss. The exclusion criteria were defined as follows: patients who underwent only soft tissue procedures, patients who did not attend the follow-up, patients with other pathology in the upper extremity (fracture, cuff tear, etc.), and patients with a follow-up period of less than 12 months time. Nine patients underwent the Latarjet procedure and six underwent iliac crest bone graft transfer. Clinical evaluation, age, gender, body mass index, range of motion, Quick Disabilities of the Arm, Shoulder and Hand (QDASH) score, Constant score, and Visual Analogue Scale (VAS) score were evaluated. Radiographic evaluation was performed with preoperative and postoperative direct radiographs and computed tomography. Mann-Whitney U test, t-test, and Fisher exact tests were used for group comparisons. The mean age of the patients was 32.6 years and the mean follow-up period was 24.9 months. When the two groups were compared, no statistical difference was found in terms of age, gender, body mass index, range of motion, Constant score, VAS score, glenoid cartilage stepping, and bone defect (p>0.05). The operation time was longer in the iliac crest bone graft transfer group compared to the Latarjet group (p<0.05). Latarjet and iliac crest bone graft transfer can be used successfully in the treatment of bony Bankart in recurrent anterior shoulder dislocations. The operation time is longer in iliac crest bone graft transfer compared to the Latarjet procedure.

Influence of the type of atlantoaxial dislocation secondary to os odontoideum on sagittal alignment and balance of the subaxial cervical spine after posterior atlantoaxial fusion.

This retrospective study aims to investigate the effect of the type of atlantoaxial dislocation due to os odontoideum on the sagittal alignment and balance of the cervical spine after posterior atlantoaxial fusion. Data of 48 consecutive patients who underwent posterior C1-C2 fusion to treat atlantoaxial dislocation/instability due to os odontoideum were retrospectively reviewed. Radiographic variables, namely the T1 slope (T1S), C1-C2 angle, C2-C7 angle, C1-C2 sagittal vertical axis (SVA), C2-C7 SVA, and modified atlas-dens interval (MADI), were measured preoperatively, immediate postoperatively, and at final follow-up. Patients were divided into three groups based on the preoperative MADI. Differences within and between groups in radiographic variables and relationships between the investigated variables were analyzed. The MADI was correlated with the preoperative to postoperative changes in the C1-C2 angle (r = 0.776, P < 0.05) and C2-C7 angle (r = -0.357, P < 0.05). In the group with anterior atlantoaxial dislocation, the C1-C2 angle and C2-C7 SVA were significantly enlarged at final follow-up (P < 0.05), while the C2-C7 angle was significantly reduced (P < 0.05). The changes in C1-C2 angle and C2-C7 angle were opposite between the posterior group and the anterior dislocation group. The direction/type of atlantoaxial subluxation correlates with the changes in lower cervical curvature after atlantoaxial fusion. Patients with atlantoaxial posterior dislocation and atlantoaxial instability are less likely than those with atlantoaxial anterior dislocation to develop loss of lordosis after posterior atlantoaxial fusion.

Reconstructing a Lay Individual’s Elbow Fracture at Santa Caterina Friary, Barcelona (15th–16th Century): The Contribution of Paleopathology to the Valorization of Bioarcheological Heritage

The paleopathological literature notably lacks the description and analysis of distal humeral fractures and their associated complications. The objectives of this study were (1) to evaluate a distal humerus fracture associated with cubitus valgus observed in the articulated right elbow of an adult male buried in the Santa Caterina Friary site in Barcelona, dating back to the modern period (15th to early 16th century), and (2) to contribute to the valorization of bioarcheological heritage. Employing macroscopic and radiographic studies, the injury was assessed. The results indicated a healed antemortem fracture, probably associated with a fall. In the AO/OTA classification, it corresponds to type 13C1.1 (complete articular fracture, articular simple, metaphyseal simple, above the transcondylar axis), accompanied by a coronoid process fracture due to anterior trochlear dislocation impact (O’Driscoll type 1 classification: transverse fracture of the distal apophysis with involvement of the sublime tubercle). This fracture, resulting in a 28° cubitus valgus and significant elbow changes, infers community support in healing and highlights the socio-economic dynamics of guilds and adaptive strategies to physical adversities. This study is one of the first to describe cubitus valgus in a historical Spanish population, offering a comprehensive view of the complexities, physical adversities, and adaptive strategies employed by individuals following an elbow fracture.

Easy and safe: A new surgical fixation -technique for acute and chronic anterior instabilities of the sternoclavicular joint: technique and results

Instabilities of the SC joint are a rare injury, accounting for only 3% of all injuries of the shoulder-girdle. While acute posterior dislocations are an emergency and require immediate surgical intervention, anterior instabilities (first and second degree according to Allman) can mostly be treated conservatively. Chronic and highly instable acute anterior instabilities often imposes a significant limitation on the lives of affected patients. Currently, there is no established therapeutic algorithm in place. This retrospective case series with prospective collection of data was performed at a level-I trauma centre. Patients treated surgically for anterior SC joint instabilities between January 2013 and December 2019 and with a minimum follow-up of 24 months were included. The injuries comprised of six acute anterior dislocations treated with tape-cerclage in a "figure-of-8" configuration; twelve patients with chronic anterior SC instabilities were treated with autologous tendon grafts. For one highly unstable chronic anterior instability in addition to the tendon graft synthetic suture material was applied. The clinical evaluation consisted of a physical examination and a standardized questionnaire, which included subjective and objective shoulder scores. Out of 24, 19 patients (79%) with an average age of 32 years ± 15 were available for follow-up. 63% of the patients were male. After a mean follow-up of 57 months, the mean age- and sex-adapted Constant-Murley Shoulder Score (CS) of acute anterior luxations amounted to 90 points ± 20, Nottingham Clavicle Score (NCS) to 81 points ± 22 and DASH Score to 11 points ± 18. Chronic anterior instabilities had a mean CS of 90 points ± 12, NCS of 83 points ± 17 and DASH Score of 4 points ± 5. The study shows a complication rate of 10%. Two patients underwent revision surgery. To conlude, monocortical SCJ fixation in a "figure-of-8" fashion presents a low risk for complication and a low revision rate and can achieve equally good functional outcome after the treatment of highly unstable acute and chronic anterior SCJ instabilities than other published techniques. Our approach presents less risk to the neurovascular structures of the mediastinum than other published techniques requiring bicortical drilling, therefore making the technique more accessible to hospitals without a cardiothoracic surgical background.

Evaluation of the scapulohumeral distraction technique for anterior shoulder dislocation: a randomized controlled trial

IntroductionShoulder dislocation is a common injury presenting in emergency Department. Numerous methods have been described in the literature for glenohumeral reduction. These methods can be divided into two groups: traction maneuvers and the combination of traction with scapula manipulation techniques. In this article, we introduced a new maneuver for shoulder reduction, namely, the combination of traction with handling the scapula (scapulohumeral distraction, SHD) and compare it to the Hippocratic Method (HT). Materials and methodsThe study took place from November 2021 to September 2023. A total of 96 patients with acute anterior shoulder dislocation were enrolled in the study. Eighty-seven patients, who met all inclusion criteria, were randomly assigned to one of the two groups (SHD and HM). We evaluated each method for success rate, time to relocation, complications over a follow-up period of one month, patients’ satisfaction and pain level during the procedure. ResultsBoth methods had comparable success rates (SHD 95.3% vs. HM 93.2%, p=.833) while no complications where observed. However, SHD method required significantly less procedure time (p=.001). Moreover, patients in SHD group reported significantly less pain (p=.012) and greater satisfaction (p=.003) levels. Furthermore, when we assessed relocation time, pain and patient satisfaction as a function of recurrence, there were no statistically significant differences between the 2 techniques. Similarly, the evaluation of relocation time for both techniques as a function of BMI and age did not indicate statistically significant differences. ConclusionScapulohumeral distraction technique (SHD) represents a safe, anatomically based and simple method for shoulder reduction. It showed a statistically significant decrease in relocation time and pain, with patients mentioned higher satisfaction rates compared to the classical Hippocratic method. Nonetheless, there were no statistically significant differences between the two techniques regarding success rate.

The Efficacy of Inhaled Methoxyflurane Versus Intravenous Sedation for the Reduction of Acute Shoulder Dislocation

Purpose: Anterior shoulder dislocation is one of the most common emergency orthopedic conditions. In general practice, intravenous sedation is the standard treatment to relax patients during shoulder reduction procedures. Sedatives and analgesics are drugs that have side effects after administration, especially when administered intravenously. They can depress neurological function and cause respiratory and cardiovascular system side effects. Self-inhaled methoxyflurane relieves moderate to severe pain. Hospitals may benefit from minimized respiratory and cardiovascular side effects. Methods: This randomized controlled trial included 50 patients who were randomly assigned to two groups: the inhaled methoxyflurane group (Inh Group) and the intravenous sedation group (IV Group). All patients were assessed for efficacy, procedure duration, pain score during reduction, patient satisfaction, and adverse effects. Results: Fifty patients satisfied the inclusion requirement: 25 each in the Inh and IV Groups. Reduction was successfully achieved in 92% and 88% of the patients in the Inh and IV Group, respectively. The mean procedural time was 6.4 min and 15.4 min the Inh and IV Group, respectively. Moreover, the mean recovery time was 22.5 min in the Inh Group and 32.4 min in the IV Group. Conclusions: Inhaled methoxyflurane has better efficacy in reducing acute shoulder dislocation than intravenous sedation alone. Procedural and recovery times were shorter in the Inh Group. Adverse events (hemodynamic instability, desaturation, nausea, vomiting, drowsiness, and dizziness) were more frequent in the IV Group than in the Inh Group.

The “glass shoulder”: Patients’ lived experiences of a traumatic shoulder dislocation – A qualitative study

BackgroundAnterior shoulder dislocations have a high recurrence rate, often necessitating stabilizing surgery, with residual long-term fear of reinjury. ObjectivesTo explore patients’ experiences of anterior shoulder dislocations in relation to their lives, well-being, fear of reinjury, and future perspectives. DesignQualitative study. MethodsWe interviewed fourteen individuals (median age 27.5 yrs, range 21–40; two women) with traumatic anterior glenohumeral dislocation within 5 years, with or without past stabilizing surgery. We analysed data using Interpretive Description. ResultsWe constructed three main themes. (1) Downward wellness spiral: The injury shattered their lives, influencing their self-identity and -confidence. Sleep disturbances added to stress levels, loss, depression and grief. The re-injury risk could lead to social isolation. (2) Out of arm's reach: Recurrences led to frustration as the prior surgery and rehabilitation appeared to have been unsuccessful, having to start again. Support from healthcare providers and whānau/family was crucial to regain trust in the body. (3) Obligatory compromise: Over time, some individuals accepted the re-injury risk, learnt to heed warning signals, or compromised by avoiding specific social and recreational activities, changing their sports or to other roles in their preferred sport, and adapting work-related and daily tasks. ConclusionParticipants described in-depth socio-emotional responses following shoulder dislocations. Most participants described an ongoing interplay between fear and confidence in their shoulder. Healthcare provider support and professional relationship, on-going shoulder-related strengthening, and risk mitigation strategies were important to facilitate and maintain confidence and self-efficacy, and to re-consider and adjust the participant's goals when needed.

Case Report: Photobiomodulation improves shoulder functionality after acute traumatic anterior dislocation associated with Hill-Sachs bone lesion’

Photobiomodulation (PBM) has demonstrated positive effects on bone healing after fracture. This case report describes a skateboard-related shoulder anterior dislocation with Bankart and Hill-Sachs lesions. After a non-invasive reduction, the patient received conservative treatment with PBM. PBM was started on the accident day and continued daily for 30 days, followed by bi-weekly irradiation for 33 months. In the initial 30 days, the patient’s pain decreased, and the shoulder function was recovered with no pain, swelling, or bruising. On day 28, there was a reduction in edema compared to the initial injury and a full shoulder recovery for daily and sports activities. Physical examinations confirmed shoulder joint stability and the images at 33 months demonstrated Hill-Sachs lesion healing and significant Bankart lesion repair. In conclusion, PBM can induce recovery, alleviate pain, and facilitate functional rehabilitation. Additional clinical trials are required to validate the efficacy of this complementary therapy.

Role of CT Scan in Preoperative Evaluation of Bone Loss in Anterior Shoulder Instability Using the On Track and Off Track Concept

Abstract Purpose The purpose of this study was to assess the role of CT scan in preoperative evaluation of glenoid and humeral head bone loss in cases of recurrent anterior shoulder joint dislocation using on track and off track concept and whether it can be used to predict engagement during arthroscopy. Patients and Methods In the period from June 2019 to October 2022, this study was conducted in Ain Shams University hospitals including 40 cases with recurrent anterior shoulder dislocation. CT scan with 3D reconstruction was done to calculate the width of the glenoid track using the best fit circle method as well as the Hill Sachs interval. We used the on-track off-track method to predict engagement and these results were compared with the findings related to engagement seen during arthroscopy Results Using the on-track /off-track technique on CT images, 22 of the 25 engaging (off-track) lesions was predicted correctly (sensitivity, 88%).While 13 of the 15 cases that did not engage (on-track) was correctly predicted (specificity, 86.7%). Overall, the accuracy of the on-track off-track method was 87.5% with a positive predictive value (PPV) of 91.7% and negative predictive value (NPV) of 81.3%. The on-track /off-track method was found to be a significant predictor of engagement as there is no statistically significant difference (p = 0.18) between this method and arthroscopic findings. Conclusion Our study showed that using the on-track off-track method by CT scan can accurately assess the glenoid and humeral head bone losses seen in patients with anterior shoulder instability for predicting the presence of engagement, or off-track, lesions. This technique can be used for preoperative evaluation to help in deciding the type of surgical procedure performed on patients with anterior shoulder instability.

Short-Term Results after Reversed Total Shoulder Arthroplasty

Abstract Purpose Massive rotator cuff tear, with or without arthritis and proximal humerus fracture non-union or malunion, lead to the loss of center of rotation of shoulder, while anatomical total shoulder arthroplasty does not provide a stable center of rotation, Therefor reversed total shoulder arthroplasty (RTSA) is the suitable method for these indications, as well as in elderly patients with primary glenohumeralosteoarthritis because anatomical total shoulder arthroplasty has the risk of failure either due to loosening of glenoid component or cuff tear. This study aimed to determine the short-term results after RTSA in patients a with massive cuff tear, acute proximal humerus fracture, proximal humerus fracture malunion or non- union, and primary glenohumeralosteoarthritis. Methods This one arm clinical trial (interventional study) conducted in Ain Shams University Hospitals included 16 patients who underwent RTSA. Short-term outcomes included constant score, American Shoulder and Elbow Surgeon (ASES) score, and range of motion (ROM). Patients with rotator cuff arthropathy, massive irreparable cuff tear with or without glenohumeralarthritis, elderly patients with acute complex proximal humerus fracture, malunited or nonunited proximal humerus fracture, and patients with glenohumeralosteoarthritis were included. Patients who were aged &amp;lt;50 years were excluded, as well as patients with axillary nerve injury or deltoid muscle dysfunction. Results This study included 16 patients, including 8 males and 8 females. The mean age was 64.19 years and the duration of follow up-was 1 year postoperatively. Seven Patients with massive irreparable cuff tear were included, of them, 1 had associated anterior shoulder instability and recurrent anterior dislocation, 3 had a four-part proximal humerus fracture, 2 had fracture dislocation, 2 had proximal humerus fracture non –union, 1had neglected dislocation, and 2 had glenohumeralosteoarthritis. Outcomes were followed using constant and ASES scoring systems, and ROM. The global postoperative gain was statistically significant (p &amp;lt; 0.001). Complication in the form of dislocation occurred in one case that had RTSA after fracture non-union. Conclusion Good clinical and functional outcomes were achieved after RTSA, not only for classic massive cuff tear indication, but for other disorders, such as acute proximal humerus fracture, fracture non-union, and primary glenohumeralosteoarthritis. However, the outcomes after irreparable cuff tear were the best among all indications, while fracture non-union had the least improvement in clinical outcomes. Improvements in prosthesis design, surgeon’s experience, and clinical results are necessary to optimize this treatment for many shoulder conditions.

Single anterior shoulder dislocation patients demonstrate higher rates of posterior labral repair and biceps procedures than multiple dislocators at the time of arthroscopic stabilization surgery

IntroductionThe purpose of this study is to identify and compare demographic, clinical, historical, and intra-operative variables in patients who have received arthroscopic treatment for single versus multiple anterior shoulder dislocations. MethodsThis is a retrospective chart review of patients who underwent arthroscopic labral repair of the shoulder by six surgeons at a single institution between 2012-2020. Patients with a documented anterior shoulder dislocation were included. Patients with pain-only, subluxation-only, multi-directional or posterior instability, and prior shoulder surgeries of any kind were excluded. Studied variables included age, sex, laterality, body mass index, contact/collision sports, Charlson Comorbidity Index, tobacco use, number of dislocations (1, >1), labral tear size, time from first dislocation to surgery, anchor number, and concomitant procedures. Study groups were compared using student’s t-tests and Mann-Whitney U test for continuous variables and Chi-Square or Fisher’s Exact tests for discrete variables with a significance of 0.05. Results633 patients were identified and 351 [85 single dislocators (SD), 266 multiple dislocators (MD)] met inclusion criteria (mean age: 27 years; range: 14-71 years). There were no demographic differences between study groups. SD received surgery significantly sooner at 17 ± 44 months after injury, while MD received surgery 53 ± 74 months post-initial dislocation. SD (30/85, 35%) were significantly more likely than MD (56/266, 21%) to receive concomitant posterior labrum repair. MD (46/266, 17%) were significantly more likely than SD (5/85, 6%) to receive a Remplissage. SD (11/85, 13%) were significantly more likely than MD (11/266, 4%) to receive a concomitant biceps tenotomy/tenodesis. There were no other significant differences in injury or surgery characteristics. ConclusionMD will have more time between their initial dislocation and arthroscopic labral repair and were more likely to receive a Remplissage procedure, yet were less likely than SD to receive a concomitant posterior labral repair or biceps tenodesis/tenotomy despite no differences in age, sex, and activity level. Whether the greater extent of labrum injury in SD is due to a more severe initial injury versus earlier recognition and intervention requires further study.

Short-Term Results after Reverse Total Shoulder Arthroplasty

Abstract Background: The loss of the shoulder’s center of rotation is caused by massive rotator cuff tears, which can occur with or without arthritis and proximal humerus fractures that are nonunion or malunion. Because anatomical total shoulder arthroplasty cannot provide a stable center of rotation, reverse total shoulder arthroplasty (RTSA) is the appropriate procedure for these indications and in older patients who have primary glenohumeral osteoarthritis. Anatomical total shoulder arthroplasty carries a risk of failure because of the loosening of the glenoid component or cuff tear. The purpose of this study was to determine the short-term outcomes following RTSA in patients who had primary glenohumeral osteoarthritis, acute proximal humerus fractures, malunited or nonunited proximal humerus fractures, and massive cuff tears. Materials and Methods: This single-arm clinical trial (interventional study) was done in Ain Shams University Hospitals; 16 patients were included who underwent RTSA. Constant score, American Shoulder and Elbow Surgeon score, Visual Analog Scale score, and range of motion (ROM) were the short-term outcomes. Patients with cuff tear arthropathy, irreparable cuff tear with or without glenohumeral arthritis, elderly patients with unreconstructable proximal humerus fracture, proximal humerus fracture malunion or nonunion, and patients with glenohumeral osteoarthritis were included. Patients under the age of 50, as well as those with deltoid muscle dysfunction or injuries to the axillary nerve, were excluded. Results: There were 16 patients in this study, 8 of whom were male and 8 of whom were female. The follow-up period lasted 2 years following surgery, with a mean age of 64.19 years. The study included 7 patients with irreparable cuff tears one of them had associated anterior shoulder instability and recurrent anterior shoulder dislocation. One patient had a neglected shoulder dislocation, two patients had proximal humerus fracture dislocation, two patients had a nonunited proximal humerus fracture, three patients had unreconstructable proximal humerus fracture, and two had glenohumeral osteoarthritis. Conclusion: Not only did RTSA provide good clinical and functional outcomes for the standard indication of a massive cuff tear, but it also proved beneficial for other disorders such as primary glenohumeral osteoarthritis, nonunited fracture, and acute proximal humerus fracture. Among all indications, irreparable cuff tears yielded the highest results; nonunited fractures displayed the least improvement regarding clinical outcomes. Enhancements in the design of prostheses, the expertise of surgeons, and clinical outcomes are crucial to maximize their effectiveness in treating various shoulder disorders.

Arthroscopic Bankart Repair Using 1 Anterior Portal Has a Shorter Surgical Time and Comparable Clinical Results With the Standard 2-Portal Technique

PurposeTo assess the modified one anteriorportal Bankart repair and compare it to the two-portal Bankart repair in terms of surgical time, functional scores, and recurrent dislocation. Material and MethodsPatients who underwent Bankart repair from 2014 to 2021 were identified and separated into two groups: a modified one anterior portal group and a two anterior portal group. The inclusion criteria were being >18 years old, having a recurrent anterior shoulder dislocation with a Bankart lesion, and having a minimum of 2 years of follow-up. Patients were evaluated for their clinical results using the American Shoulder and Elbow Surgeons (ASES) score, the Western Ontario Shoulder Instability (WOSI) Index, and the Oxford Shoulder Instability Score (OSIS) pre- and post-operatively. The duration of surgery and recurrent instability were recorded. To prevent suture tangling in the modified one-portal group, two techniques were performed: "cannula in canulla” and "cannula in and out." ResultsA total of 42 subjects were included in this study, with 20 in the modified one portal group and 22 in the two-portal group. There were no statistically significant differences between the two groups in clinical scores obtained after two years of surgery (ASES score p =0.5, WOSI index p =0.22, and OSIS score p =0.32). The average surgical duration in the modified one-portal group (65.7±15.8) was significantly shorter than the average surgery duration in the two-portal group (81.1±27.2). (p=0.03). There was no statistically significant difference between the two groups for recurrent instability. (p=1.0) ConclusionBankart repair performed through a modified one anterior portal technique has a shorter surgical time and similar clinical outcomes as the two-portal technique.

Effectiveness analysis of double EndoButton suture fixation Latarjet procedure for treatment of anterior shoulder dislocation with glenoid bone defect caused by military training injuries

To investigate the effectiveness of double EndoButton suture fixation Latarjet procedure in the treatment of shoulder anterior dislocation with glenoid bone defect caused by military training injuries. The clinical data of 14 patients with anterior shoulder dislocation with glenoid bone defect due to military training injuries who met the selection criteria and admitted between August 2021 and December 2022 were retrospectively analyzed. All patients were male, the age ranged from 21 to 38 years, with an average of 26.8 years. The time from initial dislocation to operation was 6-15 months, with an average of 10.2 months. Anterior shoulder dislocation occurred 5-12 times, with an average of 8.2 times. All glenoid bone defects were more than 10%, including 5 cases of 10%-15%, 8 cases of 15%-20%, and 1 case of 24%. All patients were treated by double EndoButton suture fixation Latarjet procedure. The operation time and complications were recorded. The shoulder function and pain were evaluated by the American Association for Shoulder and Elbow Surgery (ASES) score, Rowe score, Instability Severity Index Score (ISIS), and visual analogue scale (VAS) score before and after operation. The range of motion of the shoulder was recorded, including forward flexion, 0° external rotation, and abduction 90° external rotation. The position, healing, and resorption of the bone mass were evaluated by three-dimensional CT of shoulder joint after operation. All patients successfully completed the operation, and the operation time was 100-150 minutes, with an average of 119.7 minutes. There was no complications such as infection, vascular and nerve injury. All patients were followed up 12-20 months, with an average of 15.6 months. During the follow-up, 4 patients had bone mass separation, absorption, and recurrent anterior dislocation, and the shoulder joint fear test was positive. Imaging of the remaining patients showed that the bone mass healed well, no anterior dislocation recurrence occurred, and the healing time was 3-7 months (mean, 4.7 months). At last follow-up, the range of motion, ASES score, Rowe score, ISIS score, and VAS score of the patients significantly improved when compared with those before operation ( P<0.05). The effectiveness of double EndoButton suture fixation Latarjet procedure for the treatment of anterior shoulder dislocation with glenoid bone defect caused by military training injury is satisfactory.

Mid-term effectiveness of modified arthroscopic suture button fixation Latarjet procedure for treatment of recurrent anterior shoulder dislocations

To summarize mid-term effectiveness of modified arthroscopic suture button fixation Latarjet procedure for treatment of recurrent anterior shoulder dislocations. Between January 2018 and October 2020, 30 patients with recurrent anterior shoulder dislocations were treated with modified arthroscopic suture button fixation Latarjet procedure. There were 19 males and 11 females with an average age of 27.3 years (range, 18-41 years). The shoulder dislocation occurred 3-7 times, with an average of 4.9 times. The time from the last dislocation to operation was 3-10 days, with an average of 4.1 days. Glenoid defects exceeded 20% in all cases. There were 27 cases of Hill-Sachs lesions. The joint pain and function were estimated by visual analogue scale (VAS) score, University of California, Los Angeles (UCLA) score, Rowe score, American Association for Shoulder and Elbow Surgery (ASES) score, Walch-Duplay score, and the range of external rotation at 0° and external rotation at 90° abduction of shoulder before operation and at 1 month, 6 months, and last follow-up. The X-ray film, CT scan and three-dimensional reconstruction were reviewed to observe the position, healing, and absorption of the coracoid graft, correction of glenoid defect, and joint degeneration. The operation time ranged from 51 to 79 minutes, with an average of 68.4 minutes. All incisions healed without complications such as nerve or blood vessel injury. All patients were followed up 36-60 months with an average of 44.6 months. The VAS score, UCLA score, Rowe score, ASES score, Walch-Duplay score, and the range of external rotation at 0° and external rotation at 90° abduction after operation significantly improved when compared with preoperative values ( P<0.05). All indicators further improved with time, and the differences between different time points after operation were significant ( P<0.05). Imaging review showed that the coracoid graft was located in the anteroinferior glenoid at 1 day after operation, and no occurrence of shoulder osteoarthritis was found during follow-up. The anatomical structure of the glenoid was normal, and no delayed healing or non-union of the coracoid graft occurred. At 20 months after operation, arthroscopic re-exploration was performed in 1 case due to fracutre caused by falling injury revealed the good shaping of the coracoid graft, smooth glenoid, and no bone resorption or osteoarthritis. For recurrent anterior shoulder dislocations, the modified arthroscopic suture button fixation Latarjet procedure can obtain good recovery of shoulder function and low incidence of complications and has a good mid-term effectiveness.