Arthroscopic Repair versus Non-operative Treatment of First-time Traumatic Anterior Shoulder Dislocations: A Numbers-needed-to-treat Analysis for Prevention of Recurrent Dislocations

BACKGROUND: Arthroscopic surgical repair is a better intervention than non-operative (conservative) treatment for patients with shoulder dislocations. This systematic review determined the numbers-needed-to-treat (NNT) and relative risk reduction (RRR) associated with arthroscopic surgical repair versus non-operative treatment in reducing recurrence rates among patients with first-time traumatic anterior shoulder dislocations. METHODS: We searched Google Scholar, MEDLINE, SPORTDiscus, and CINAHL from inception in 2015. All articles had to compare arthroscopic surgical repair and non-operative treatment and be written in English. We used the total number of subjects and the number of recurrent dislocations within each treatment to calculate the NNT and RRR for each study and the pooled data. RESULTS: Six articles were selected and all clearly demonstrated that the arthroscopic surgical repair was more effective than non-operative treatment in reducing the recurrence episodes. The pooled NNT was 1.76 (95% confidence interval [CI]=NNT to benefit 1.50-2.13) and the pooled RRR was 86.0% (95% CI=77.0%-92.0%) among individuals who underwent arthroscopic repair. The average follow-up time was 56 months. CONCLUSIONS: A Strength of Recommendation Taxonomy level of evidence of 1 with a grade A recommendation supports the use of arthroscopic surgical repair over non-operative treatment in prevention of first-time traumatic anterior shoulder dislocations. We suggest that sports medicine practitioners consider the patients' age, occupation, and physical activity level when making a clinical decision.

Arthroscopic Repair versus Non-operative Treatment of First-time Traumatic Anterior Shoulder Dislocations: A Numbers-needed-to-treat Analysis for Prevention of Recurrent Dislocations

BACKGROUND: Arthroscopic surgical repair is a better intervention than non-operative (conservative) treatment for patients with shoulder dislocations. This systematic review determined the numbers-needed-to-treat (NNT) and relative risk reduction (RRR) associated with arthroscopic surgical repair versus non-operative treatment in reducing recurrence rates among patients with first-time traumatic anterior shoulder dislocations. METHODS: We searched Google Scholar, MEDLINE, SPORTDiscus, and CINAHL from inception in 2015. All articles had to compare arthroscopic surgical repair and non-operative treatment and be written in English. We used the total number of subjects and the number of recurrent dislocations within each treatment to calculate the NNT and RRR for each study and the pooled data. RESULTS: Six articles were selected and all clearly demonstrated that the arthroscopic surgical repair was more effective than non-operative treatment in reducing the recurrence episodes. The pooled NNT was 1.76 (95% confidence interval [CI]=NNT to benefit 1.50-2.13) and the pooled RRR was 86.0% (95% CI=77.0%-92.0%) among individuals who underwent arthroscopic repair. The average follow-up time was 56 months. CONCLUSIONS: A Strength of Recommendation Taxonomy level of evidence of 1 with a grade A recommendation supports the use of arthroscopic surgical repair over non-operative treatment in prevention of first-time traumatic anterior shoulder dislocations. We suggest that sports medicine practitioners consider the patients' age, occupation, and physical activity level when making a clinical decision.

Inestabilidad anterior del hombro. Resultados con la técnica de Bristow / Glenohumeral instability. Results with Bristow technique

Introducción: La luxación recidivante de hombro es una patología frecuente en pacientes jóvenes, laboralmente activos. Existen numerosas técnicas quirúrgicas para la inestabilidad gleno-humeral. La técnica de Bristow, discutida por no ser anatómica y por sus complicaciones, continúa vigente debido al bajo índice de reluxaciones. Los objetivos fueron determinar el índice de recidiva, alteraciones funcionales e índice de consolidación del injerto. Materiales y Métodos: Se evaluaron 24 pacientes del sexo masculino, de entre 19 y 40 años, operados por luxación anterior recidivante de hombro según la técnica de Bristow, entre enero de 2003 y agosto de 2011. Se evaluó la tasa de reluxación, la función articular según el puntaje de Constant y el posicionamiento del injerto con respecto a la superficie articular con tomografía y radiografías para evaluar la consolidación del injerto. Se registraron las complicaciones quirúrgicas. Resultados: Todos los pacientes eran hombres, con rango de edad de 19 a 40 años. La causa fue traumática en 24 pacientes. Dieciséis pacientes presentaron más de 3 episodios de luxación prequirúrgicos. Según la escala de Constant, 21 obtuvieron entre 96 y 100 puntos, y los restantes, entre 90 y 95 puntos. No hubo nuevos episodios de luxaciones. La tomografía mostró la consolidación en todos los casos. Un paciente tuvo una imagen osteolítica alrededor del tornillo, sin compromiso funcional del hombro. Conclusión: La técnica de Bristow para tratar la luxación anterior recidivante de hombro provocó un bajo índice de complicaciones, con resultados funcionales entre excelentes y buenos. No hubo episodios de reluxación y se logró la consolidación del injerto óseo en todos los casos.

Background: Recurrent shoulder dislocation is a common condition in young and active patients. There are numerous surgical techniques for the resolution of glenohumeral instability. Bristow technique is criticized for not being anatomic and for its complications, but it remains a useful procedure because of the low rate of recurrent dislocations. The purpose of this study was to determine the rate of recurrence, functional impairment and rate of graft union. Methods: Twenty four men aged 19-40 years treated for recurrent anterior shoulder luxation with Bristow procedure were evaluated between January 2003 and August 2011. Postsurgical recurrence and joint function were evaluated clinically (Constant score) and with complementary methods (X-ray/CT). Surgical complications were registered. Results: All patients were males aged 19-40 years. A traumatic cause was detected in all patients. Sixteen patients presented >3 episodes of dislocation before the surgical procedure. According to the Constant scale, 21 patients had 96-100 points, and the remaining obtained 90-95 points. No episode of redislocation was detected. Computed tomography showed consolidation in all cases. One patient had an osteolytic image around the screw, but it was not reflected in the functional state of the shoulder. Conclusion: Bristow technique for the treatment of recurrent dislocation of the shoulder showed low rate of complications with excellent and good functional results. There were no cases of redislocations and consolidation of the graft was achieved in all cases.

Polished Tapered Femoral Stem Displacement during the Closed Reduction of a Redislocated CementedBipolar Hemiarthroplasty of the Hip: A Case Report / 대한정형외과학회잡지

Redislocation of bipolar hemiarthroplasty is not a simple complication. When redislocation of bipolar hemiarthroplasty occurs, open reduction must be considered. Displacement of the polished tapered femoral stem could occur through the unwanted traction force during the reduction of the dislocated cemented hip arthroplasty as a complication. We experienced displacement of the polished tapered femoral stem during closed reduction of a redislocated cemented bipolar hemiarthroplasty. We suggest that preoperative analysis for the cause and status of the dislocation is essential and open reduction should be considered if closed reduction is not thought to be suitable for a polished femoral stem.

The Redislocation after Open Reduction and Salter's Innominate Osteotomy in Congenital Dislocation of the Hip / 대한정형외과학회잡지

The complications of Salter's innominate osteotomy in the treatment of congenital dislocation of the hip were avascular necrosis of the femoral head, hematoma, rotation of distal pelvic fragment, infection, fracture of femoral shaft and redislocation. Among them the causes of redislocation were technical failure, immobilization failure and absorption the bone graft, etc. We experienced a case of redislocation after open reduction and Salter s innominate osteotomy in congenital dislocation of the hip which was induced by a foreign body reaction to the suture material.