Surgical Approaches, Pitfalls and Outcomes of Posterior Fracture Dislocations of the Shoulder—A Critical Review

Ho, Wing-Hang Angela; Chung, Chor-Yat Stephen; Ho, Yuen-Fong

doi:10.1016/j.jotr.2013.05.002

Cited by 2 publications

(3 citation statements)

References 8 publications

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“…Although the true incidence of a spontaneously reduced tibiofemoral dislocation may be difficult to determine, none of our 78 patients in the non-dislocated group described a manual or spontaneous reduction occurring in the field. Initial evaluation should include a thorough patient history, physical examination, and imaging, with particular attention to vascular status, which has the greatest emergency treatment implications 31 .…”

Section: Discussionmentioning

confidence: 99%

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Increased Neurovascular Morbidity Is Seen in Documented Knee Dislocation Versus Multiligamentous Knee Injury

Kahan

Schneble

Don

et al. 2021

Journal of Bone and Joint Surgery

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Background: The terms "knee dislocation" and "multiligamentous knee injury" (MLKI) have been used interchangeably in the literature, and MLKI without a documented knee dislocation has often been described as a knee dislocation that "spontaneously reduced." We hypothesized that MLKI with documented tibiofemoral dislocation represents a more severe injury than MLKI without documented dislocation. We aimed to better characterize the injuries associated with documented knee dislocations versus MLKIs without evidence of tibiofemoral dislocation.Methods: A total of 124 patients who were treated for an MLKI or knee dislocation to a single level-I trauma center between January 2001 and January 2020 were retrospectively reviewed. Patients were stratified into 2 groups, those with and those without a documented knee dislocation, and 123 of 124 patients were included in the analysis (78 in the nondislocated group and 45 in the dislocated group). Data regarding patient demographics, injury pattern, and associated neurovascular injury were collected and compared between groups.Results: Dislocated MLKIs, compared with non-dislocated MLKIs, had higher rates of peroneal nerve injury (38% versus 14%, respectively; p = 0.004), vascular injury (18% versus 4%; p = 0.018), and an increased number of medial-sided injuries (53% versus 30%; p = 0.009). There was no difference between dislocated and non-dislocated MLKIs in the number of bicruciate ligament injuries (82% versus 77%, respectively; p = 0.448), or lateral-sided injuries (73% versus 74%; p = 0.901).Conclusions: Dislocated MLKIs were found to have increased rates of neurovascular injury compared with nondislocated MLKIs, suggesting that knee dislocation and MLKI may not be synonymous in terms of associated injuries. Not all MLKIs are the result of a knee dislocation, and thus a documented tibiofemoral dislocation is a distinct entity that carries a greater risk of neurovascular compromise. We propose that these terms not be used interchangeably as previously described, and also that a high degree of vigilance must be maintained to evaluate for potential limbthreatening neurovascular injuries in any type of MLKI.

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Section: Discussionmentioning

confidence: 99%

“…All periarticular fractures of the tibiofemoral or patellofemoral joint that contribute to tibiofemoral instability were also included and were subclassified with use of the Moore classification 30,31 . Examples of these types of fracture-dislocations are shown in Figures 3 and 4.…”

Section: Methodsmentioning

confidence: 99%

Increased Neurovascular Morbidity Is Seen in Documented Knee Dislocation Versus Multiligamentous Knee Injury

Kahan

Schneble

Don

et al. 2021

Journal of Bone and Joint Surgery

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“…Ho et al reported three approaches in the surgical treatment of this complex lesion, including the deltopectoral approach (two cases), the utility approach (four cases) and the deltopectoral approach combined with the limit posterior deltoid‐splitting approach (three cases). Similarly, Trikha et al reported the deltopectoral approach combined with the limited posterior deltoid‐splitting approach in six cases.…”

Section: Discussionmentioning

confidence: 99%

Open reduction through a posterior incision in the surgical treatment of shoulder posterior dislocation associated with proximal humeral fractures

Shen

Jiang

2019

ANZ Journal of Surgery

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Background:We explored the surgical technique of reducing the humeral head and repairing the fractures through a combined approach in the treatment of this complex injury. Methods: Six patients with posterior shoulder dislocations associated with proximal humerus fractures were enrolled in this study. The posteriorly dislocated head was first reduced through a shoulder posterior incision and the ruptured posterior capsular tissues were repaired simultaneously using a suture anchor. The fractures were then reduced and fixed with a PHILOS through a deltopectoral approach. The affected shoulders were immobilized in a neutral position for 6 weeks postoperatively with a customized orthosis and then permitted active shoulder exercises after removal of the orthosis. At the last visit, union of the fractures was evaluated. Degrees of anterior forward of the affected shoulder were recorded. Outcomes were evaluated according to UCLA and Constant criteria. Results: Six patients were followed up for an average of 24.5 AE 7.4 (range 13-35) months. At the last visit, the mean degree of anterior forward was 171.7 AE 7.5 (range degrees. An average of 32.9 AE 1.2 (range 31-34) points was obtained according to UCLA criteria, demonstrating excellent and good results in two and four cases, respectively. The mean Constant score was 87.3 AE 4.1 (range 83-92) points. Conclusions: The dislocated humeral head can be reduced through a posterior approach, while fractures can be reduced and fixed through a deltopectoral approach. This technique has the advantages of simplicity and its minimally invasive approach for reducing the dislocation.

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Surgical Approaches, Pitfalls and Outcomes of Posterior Fracture Dislocations of the Shoulder—A Critical Review

Cited by 2 publications

References 8 publications

Increased Neurovascular Morbidity Is Seen in Documented Knee Dislocation Versus Multiligamentous Knee Injury

Increased Neurovascular Morbidity Is Seen in Documented Knee Dislocation Versus Multiligamentous Knee Injury

Open reduction through a posterior incision in the surgical treatment of shoulder posterior dislocation associated with proximal humeral fractures

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