Locked Posterior Dislocation of the Shoulder: Treatment Using Rotational Osteotomy of the Humerus

Keppler, P.; Holz, U.; Thielemann, F. W.; Meinig, Richard P.

doi:10.1097/00005131-199408000-00003

Cited by 107 publications

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“…Nicola et al [11] described a modification of McLaughlin's procedure which involved transposition of the subscapularis tendon along with the lesser tuberosity into the defect and securing it with a screw. Locked posterior dislocation of the shoulder can also be treated by rotational osteotomy of the surgical neck of humerus [12].…”

Section: Discussionmentioning

confidence: 99%

Traumatic Bilateral Posterior Fracture-Dislocation of Shoulders

Jayanthi¹,

Logan²,

Wootton

2004

Eur J Trauma

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European Journal of Trauma Ab stractBilateral posterior fracture-dislocation of shoulders (BPFDS) is a rare injury and is most commonly sustained after epileptic seizure, extreme trauma or electrocution. A unique case of isolated BPFDS as a result of a fall from a bicycle in a healthy young man is presented. Unilateral posterior fracture-dislocation of the shoulder as a result of trauma is rare and such an injury occurring bilaterally is yet to be reported in the literature. BPFDS is associated with rotator cuff tears, reverse Hill-Sachs lesion and posterior labrum injuries. BPFDS if not treated promptly can lead to avascular necrosis of the head of humerus. Diagnosis of BPFDS is difficult and if there is any suspicion on the plain films, CT or MRI scans should be performed to confirm the diagnosis and define any associated injuries. Case StudyA 34-year-old man presented to Accident & Emergency after falling from his bicycle whilst traveling downhill, practicing for a race. The exact mechanism of the fall and the position on landing cannot be remembered despite having remained conscious throughout. After the accident, the patient managed to carry his bike to the road. The only symptom that the patient complained of was severe pain in both shoulders. He was otherwise fit and well with no past medical history of epilepsy or previous shoulder injury. On examination, the normal contours of both shoulders were lost and the arms were held adducted. He was unable to move either arm at the shoulder because of pain. Neurologic examination demonstrated the axillary nerves and all other branches of the brachial plexus to be intact. A full secondary survey did not reveal any other injuries. Anteroposterior (AP) X-ray of the right shoulder ( Figure 1a) showed an undisplaced fracture of the surgical neck of humerus extending into the metaphysis distally, and the axillary view (Figure 1b) demonstrated posterior dislocation of the humeral head. AP view of left shoulder (Figure 2a) showed deformity of the humeral head, whereas the axillary view (Figure 2b) demonstrated posterior dislocation of the shoulder with a displaced surgical neck and metaphyseal humeral fracture.His right shoulder was manipulated under anesthesia ( Figure 3). The shoulder was found to be stable on screening and hence no further intervention was performed. However, his left shoulder was found to be particularly unstable and hence the injury was treated with an open reduction and cancellous screw fixation ( Figure 4). Postoperatively, his right shoulder was immobilized in a full-arm plaster held in slight abduction and external rotation attached to a thoracoabdominal spica. The left shoulder was supported in a collar and cuff.There were no immediate postoperative complications and the patient went on to complete a full course of physiotherapy. At 3-month outpatient follow-up, he had full range of movement in the right shoulder, and some restriction of abduction and external rotation in the left shoulder. At 9-month follow-up, the left shoulder had regained ...

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Section: Discussionmentioning

confidence: 99%

Traumatic Bilateral Posterior Fracture-Dislocation of Shoulders

Jayanthi¹,

Logan²,

Wootton

2004

Eur J Trauma

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“…Insgesamt [26] 1994 Rotationsosteotomie 10 6 gut bis hervorragend/ 2 befriedigend/ 2 schlecht (Rowe/Zarin) Sperling et al [48] 2004 Prothese 12 60 1 hervorragend/6 befriedigend/5 unbefriedigend (Neer) Gavriilidis et al [14] 2010 Durch die Seltenheit der Verletzung und die zahlreichen operativen Vorgehensweisen existiert ein Goldstandard in der Versorgung der dorsal verhakten Schulterluxation nicht. Als Therapiegrundsatz kann allgemein jedoch gelten, dass bei instabiler Gelenksituation nach erfolgter Reposition einer dorsal verhakten Luxation, wenn möglich, eine anatomische Defektauffül-lung angestrebt werden sollte.…”

Section: Aktuelle Literatur Und Eigene Ergebnisseunclassified

Posterior dislocation of the shoulder

2010

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ÜbersichtIm Vergleich zur sehr viel häufigeren vorderen Schulterluxation macht die dorsale Luxation nur etwa 1-5% der Fälle aus [1,5,15]. Neben der akuten dorsalen Luxation und der chronischen Instabilität stellt die dorsal verhakte Schulterluxation ein eigenständiges unfallchirurgisches Krankheitsbild dar, das in bis zu 60% der Fälle initial übersehen bzw. als Prellung oder "frozen shoulder" fehlgedeutet wird [11,13,41]. Eine sorgfältige klinische Untersuchung und entsprechende bildgebende Diagnostik sind daher unerlässlich. Der vorliegende Artikel soll einen Über-blick über die klinisch-radiologische Diagnostik und die zur Verfügung stehenden Therapieoptionen geben sowie zu erwartende Ergebnisse der operativen Therapie aufzeigen. ÄtiologieDie dorsal verhakte Luxation tritt neben direkten Traumata des Schultergelenkes auch typischerweise im Rahmen von Krampfanfällen oder Stromunfällen auf [2,17,25,33]. Es kommt zu einer generalisierten Muskelkontraktion, bei der die Kraft der Innenrotatoren und Adduktoren (Mm. latissimus dorsi, pectoralis major, subscapularis und teres major) die der Außenrotatoren (Mm. infraspinatus und teres minor) deutlich übersteigt. Neben Adduktion, Innenrotation und Flexion führt dieses Ungleichgewicht zu einer dorsokranialen Verlagerung des Humeruskopfes, die durch das Akromion kranial und das Glenoid medial begrenzt wird. Eine knöcherne Begrenzung nach dorsal besteht nicht, so dass letztendlich eine Dislokation in diese Richtung resultiert [18,30]. Nach stattgehabter dorsaler Luxation ist ein Krampfleiden auszuschließen (Alkoholentzugskrampf, Epilepsie, o. Ä.). KlassifikationFür die dorsale Schulterluxation gibt es verschiedene Klassifikationen, die im klinischen Alltag mehr oder weniger gebräuchlich sind. Abhängig von der exakten Luxationsrichtung kann zwischen der subakromialen (Humeruskopf hinter dem Glenoid und unterhalb des Akromions), der subglenoidalen (Humeruskopf hinter dem und unterhalb des Glenoids) und der subspinalen (Humeruskopf medial des Akromions und unterhalb der Spina scapulae) unterschieden werden [30].In Bezug auf die Dauer der Luxation wird zwischen einer akuten und einer chronischen dorsal verhakten Luxation entschieden. Unklarheit herrscht in der Literatur, ob eine chronische Luxation bereits nach drei oder erst nach sechs Wochen besteht [17,38,40,41]. Die Luxationsrichtung und die Dauer der Luxation sind im klinischen Alltag entscheidende Parameter für das weitere Vorgehen. Eine aktuelle Klassifikation für die posteriore Instabilität wurde 2008 von Lévig-ne vorgestellt (. Tab. 1, [29]). Heller et al. [18] schlugen 1994 bereits eine Klassifikation in Abhängigkeit von der Ätiologie der dorsalen (Sub-)Luxation vor. Im Wesentlichen unterschieden sie die traumatische von der atraumatischen Luxation. Auf ähnliche Art und Weise unterteilte Tibone 1995 nach Ätiologie (Makro-vs. Mikrotrauma) und unterschied weiterhin zwischen willkürlichen und unwillkür-lichen Luxationen [50]. Weiterhin fällt die primär verhakte hintere Luxation in die Klasse II der Klassifikation der Sch...

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“…In smaller bone defects, it is possible to transfer a plication of the subscapularis tendon and to fix it through arthroscopic suture anchors [19,20]. For osteochondral defects greater than 45%, shoulder arthroplasty [21,22], derotation osteotomy [23] of the humeral neck [23], or a transplant of the humeral defect with an allograft or with an autograft [24,25] could be performed.…”

Section: Introductionmentioning

confidence: 99%

Surgical and Rehabilitative Treatment of Misdiagnosed Posterior Dislocation of the Shoulder: Case Series

Pavone

Caruso

Chisari

et al. 2018

JFMK

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Abstract:Background: Posterior gleno-humeral joint (GHJ) dislocation is a rare injury accounting for 2.7-3% of all shoulder dislocations. Early detection is the key for an effective treatment. Poor clinical outcomes or prosthetic solutions depend on the severity of the lesions at the time of trauma and worsening of the McLaughlin lesion during the months when the dislocation remains unrecognized or untreated. The aim of the study is to report our experience in treating, and clinically and radiographically evaluate the outcomes of, four neglected posterior GHJ dislocations. Methods: Four patients with inveterate posterior dislocation of the shoulder were evaluated. In three cases, the technique of McLaughlin was performed, and in one case, plication of the subscapularis tendon was performed. During the follow up, patients were clinically evaluated using the Constant shoulder score; an imaging investigation, using X-ray integrated with computed tomography(CT) and magnetic resonance imaging (MRI), was assessed. Results: Following the Constant criteria, treated shoulders reported an excellent outcome with an average score of 91. The mean score of untreated shoulders was 92.5. The humeral appearance that resulted was radiographically well-structured. Surgical treatment with McLaughlin lesion or transposition of the subscapularis were satisfactory from a subjective and objective point of view. To perform surgery soon as possible after the traumatic episode is considered a positive prognostic factor.

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Locked Posterior Dislocation of the Shoulder: Treatment Using Rotational Osteotomy of the Humerus

Cited by 107 publications

References 0 publications

Traumatic Bilateral Posterior Fracture-Dislocation of Shoulders

Traumatic Bilateral Posterior Fracture-Dislocation of Shoulders

Posterior dislocation of the shoulder

Surgical and Rehabilitative Treatment of Misdiagnosed Posterior Dislocation of the Shoulder: Case Series

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