A study of the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations / 中国修复重建外科杂志

OBJECTIVE@#To investigate the correlation between glenohumeral joint congruence and stability in recurrent shoulder dislocations.@*METHODS@#Eighty-nine patients (89 sides) with recurrent shoulder dislocation admitted between June 2022 and June 2023 and met the selection criteria were included as study subjects. There were 36 males and 53 females with an average age of 44 years (range, 20-79 years). There were 40 cases of left shoulder and 49 cases of right shoulder. The shoulder joints dislocated 2-6 times, with an average of 3 times. The three-dimensional models of the humeral head and scapular glenoid were reconstructed using Mimics 20.0 software based on CT scanning images. The glenoid track (GT), inclusion index, chimerism index, fit index, and Hill-Sachs interval (HSI) were measured, and the degree of on/off track was judged (K value, the difference between HSI and GT). Multiple linear regression was used to analyze the correlation between the degree of on/off track (K value) and inclusion index, chimerism index, and fit index.@*RESULTS@#Multiple linear regression analysis showed that the K value had no correlation with the inclusion index ( P>0.05), and was positively correlated with the chimerism index and the fit index ( P<0.05). Regression equation was K=-24.898+35.982×inclusion index+8.280×fit index, R 2=0.084.@*CONCLUSION@#Humeral head and scapular glenoid bony area and curvature are associated with shoulder joint stability in recurrent shoulder dislocations. Increased humeral head bony area, decreased scapular glenoid bony area, increased humeral head curvature, and decreased scapular glenoid curvature are risk factors for glenohumeral joint stability.

Bilateral fracture of the shoulders following epileptic seizures: a case report / Fratura bilateral de ombros após convulsões epilépticas: relato de caso

Convulsive seizures caused by hyponatremia occur when this condition is severe and develops quickly, resulting in a brain's adaptive inability to contain brain swelling. Seizures are rarely the cause of shoulder fractures. This is a case report of bilateral humerus fracture following a single epileptic seizure caused by drug hyponatremia, an unconventional event in medical practice. A 69-year-old woman was admitted to the emergency room after a single tonic-clonic seizure with spontaneously ceased sphincter relaxation, showing Glasgow 6. No falls or restraint were reported by observers. When alert, the patient reported pain and difficulty moving both arms. During examination, the movement was li- mited to the right and left. Anteroposterior radiographs revealed bilateral fracture at the neck of humerus. To complement inves- tigation for further lesions, a computed tomography confirmed bilateral fracture-dislocation with impaction of the humeral head with the glenoid. Atraumatic bilateral fracture-dislocation of the humerus after epileptic seizure is a very rare event. It is believed that some of these diagnoses have been neglected due to the difficulty of characterizing the patient's pain in a postictal state. The importance of a detailed physical examination shall be emphasized in risk groups such as the polymedicated elderly.

Convulsive seizures caused by hyponatremia occur when this condition is severe and develops quickly, resulting in a brain's adaptive inability to contain brain swelling. Seizures are rarely the cause of shoulder fractures. This is a case report of bilateral humerus fracture following a single epileptic seizure caused by drug hyponatremia, an unconventional event in medical practice. A 69-year-old woman was admitted to the emergency room after a single tonic-clonic seizure with spontaneously ceased sphincter relaxation, showing Glasgow 6. No falls or restraint were reported by observers. When alert, the patient reported pain and difficulty moving both arms. During examination, the movement was li- mited to the right and left. Anteroposterior radiographs revealed bilateral fracture at the neck of humerus. To complement inves- tigation for further lesions, a computed tomography confirmed bilateral fracture-dislocation with impaction of the humeral head with the glenoid. Atraumatic bilateral fracture-dislocation of the humerus after epileptic seizure is a very rare event. It is believed that some of these diagnoses have been neglected due to the difficulty of characterizing the patient's pain in a postictal state. The importance of a detailed physical examination shall be emphasized in risk groups such as the polymedicated elderly.

Glenoid track «off-track¼ as a risk factor for recurrence of anterior glenohumeral instability in postoperative patients / El encarrilamiento glenoideo off-track como factor de riesgo de recidiva de inestabilidad glenohumeral en pacientes postoperados

Abstract: Introduction: Glenoid track is used to assess the engagement of Hill-Sachs lesions. The objective of this study was to identify if off-track glenoid track was a risk factor for recurrence of anterior glenohumeral instability in postoperative patients with arthroscopic anterior labrum repair. Material and methods: Sixty patients with glenohumeral instability who underwent arthroscopic repair of the anterior labrum were studied. Study group (patients with recurrence of postoperative dislocation) and control (no dislocation). Radiographic measurements were made on magnetic resonance imaging and computed tomography. Measurements of glenoid diameter, glenoid bone loss, as well as the presence and size of Hill-Sachs lesions were obtained. Later they were classified as «on-track¼ or «off-track¼. Results: Seven (11.67%) patients suffered recurrence, of which six (10%) were carriers of an off-track injury and 1 (1.67%) on-Track. 53 (88.33%) patients did not experience recurrence, of which 11 (18.33%) were carriers of an off-track injury and 42 (70%) on track. A 23.47 increased risk of recurrence of instability was interpreted in patients with «off-track¼ lesions compared to patients with «On track¼ lesions. Conclusions: Off-track injuries were a risk factor for recurrence of instability in patients who underwent Bankart-type arthroscopic repair. This allows us to recommend that the presence of lesions be routinely studied and classified as «on-track¼ or «off-track¼ to provide a better therapeutic approach.

Resumen: Introducción: El encarrilamiento glenoideo se emplea para valorar el enganche de lesiones Hill-Sachs. El objetivo de este estudio fue identificar si el encarrilamiento glenoideo off-track fue un factor de riesgo de recidiva de inestabilidad glenohumeral anterior en pacientes postoperados de reparación de labrum anterior por vía artroscópica. Material y métodos: Se estudiaron 60 pacientes sometidos a reparación artroscópica del labrum anterior. Grupo de estudio (pacientes con recidiva de luxación postoperatoria) y control (sin luxación). Las mediciones radiográficas se realizaron en resonancia magnética y en tomografía axial computarizada. Se obtuvieron mediciones del diámetro glenoideo, pérdida ósea glenoidea así como la presencia y tamaño de lesiones de Hill-Sachs. Posteriormente se clasificaron como on-track u off-track. Resultados: Siete (11.67%) pacientes sufrieron recidiva, de los cuales seis (10%) eran portadores de lesión off-track y uno (1.67%) on-track. 53 (88.33%) pacientes sin recidiva, de los cuales 11 (18.33%) eran portadores de lesión off-track y 42 (70%) on-track. Se interpretó un aumento de riesgo de recidiva de inestabilidad de 23.47 en los pacientes portadores de lesión de tipo off-track en comparación con los pacientes portadores de lesiones on-track. Conclusiones: Las lesiones off-track fueron un factor de riesgo de recidiva de inestabilidad en los pacientes a quienes se realizó reparación artroscópica tipo Bankart, lo cual nos permite recomendar que de forma rutinaria se estudie la presencia de lesiones y clasificarlas como on-track u off-track para brindar un mejor abordaje terapéutico.

Reconstrucción con bloque óseo tricortical cadavérico en luxación glenohumeral anterior recurrente con pérdida ósea glenoidea: técnica modificada de Eden Hybinette / Reconstruction with cadaveric tricortical bone block in recurrent anterior glenohumeral dislocation with glenoid bone loss: modified Eden Hybinette technique

Resumen: La luxación glenohumeral recurrente suele asociarse a pérdida ósea de la porción glenoidea, siendo la localización anteroinferior la más afectada. El entendimiento de las estructuras relacionadas así como el uso de estudios de imagen actuales tales como la tomografía axial computarizada y la resonancia magnética han permitido avanzar respecto a la comprensión de la patología, asimismo el desarrollo de materiales quirúrgicos y herramientas de mínima invasión nos permiten continuar innovando respecto a los tratamientos previamente descritos, siendo posible intervenir en detalles técnicos con la intención de mejorar los resultados. Es por eso que hemos realizado lo descrito por Eden-Hybinette utilizando injerto tricortical cadavérico con tornillos canulados como método de fijación, limitando las comorbilidades asociadas a la toma de autoinjerto, dando como resultado un amplio beneficio para el paciente durante el procedimiento quirúrgico y en el período de recuperación.

Abstract: Recurrent glenohumeral dislocation is usually associated with bone loss of the glenoid portion, with the anteroinferior location being the most affected. The understanding of the related structures, as well as the use of current imaging studies such as computed axial tomography and magnetic resonance imaging, have made progress in understanding the pathology, as well as the development of surgical materials and minimally invasive tools, they allow us to continue innovating with respect to the previously described treatments, being possible to intervene in technical details with the intention of improving the results. That is why we have done what described by Eden-Hybinette, using tricortical cadaveric graft and as fixation method, limiting the comorbidities associated with the autograft taking, resulting a wide benefit for the patient, during the surgical procedure and in the recovery period.

Luxación erecta expuesta de hombro en un niño: reporte de un caso / Erect shoulder dislocation in a child: case report / Erecto luxação do ombro em uma criança: relato de caso

La luxación erecta expuesta de hombro es una asociación lesional de muy baja frecuencia en la edad pediátrica. Son más frecuentes las lesiones fisarias y epifisarias que las luxaciones y lesiones ligamentarias. Esto es debido a la presencia de un tejido óseo con gran poder de deformidad elástica y un periostio grueso. Presentamos un caso clínico de un paciente de 11 años de edad que sufrió una luxación erecta expuesta de hombro derecho, producto de una caída de 1 metro y medio de altura. El tratamiento consistió en una limpieza quirúrgica de urgencia, reducción gleno humeral y antibioticoterapia empírica, penicinila 400.000 UI/kg/día fraccionado cada 6 hs y gentamicina 3mg/Kg/día fraccionada cada 8 h por 10 días, inmovilización por 3 semanas con cabestrillo seguido de rehabilitación, y un follow up de 2 años al final del cual el paciente no presento secuelas funcionales en la articulación glenohumeral derecha.

The exposed erect dislocation of the shoulder is a very low frequency lesion association in the pediatric age. The physical and epiphyseal lesions are more frequent than the dislocations and ligament injuries. This is due to the presence of a bone tissue with great elastic deformity power and a thick periosteum. We present a clinical case of an 11-year-old patient who suffered an exposed erect dislocation of the right shoulder, due to a fall of 1 meter and a half high. The treatment consisted of emergency surgical cleaning, humeral gleno reduction and empirical antibiotic therapy, penicinila 400,000 IU/kg/day divided every 6 hours and gentamicin 3mg/Kg/day divided every 8 hours for 10 days, immobilization for 3 weeks with a sling followed by rehabilitation, and a follow-up of 2 years at the end of which the patient did not present functional sequelae in the right glenohumeral joint.

A luxação ereta exposta do ombro é uma associação de lesão de freqüência muito baixa na idade pediátrica. As lesões físicas e epifisárias são mais freqüentes que as luxações e lesões ligamentares. Isto é devido à presença de um tecido ósseo com grande poder de deformidade elástica e um periósteo espesso. Apresentamos um caso clínico de um paciente de 11 anos de idade que sofreu uma luxação ereta exposta do ombro direito, devido a uma queda de 1 metro e meio de altura. O tratamento consistiu em limpeza cirúrgica de emergência, redução de gleno umeral e antibioticoterapia empírica, penicinila 400.000 UI / kg / dia dividida a cada 6 horas e gentamicina 3mg / Kg / dia dividida a cada 8 horas por 10 dias, imobilização por 3 semanas com tipóia seguida de reabilitação e seguimento de 2 anos no final dos quais o paciente não apresentava sequela funcional na articulação glenoumeral direita.

Frecuencia de diagnóstico de lesiones óseas en luxación glenohumeral anterior / Frecuency of diagnosis of bone lesions in cases of anterior glenohumeral dislocation

Resumen: Antecedentes: Las luxaciones de hombro son motivo común de consulta en las salas de emergencia; presentan un alto índice de recurrencia (hasta 96%) a causa de las lesiones óseas asociadas. El objetivo de este estudio fue identificar un subregistro de lesiones identificadas en radiografía inicial comparada con radiografía postreducción. Material y métodos: Se evaluaron las radiografías de 46 pacientes con sospecha de luxación glenohumeral anterior para diagnóstico e identificación de lesiones óseas iniciales; posteriormente, se realizó reducción y se analizó la serie ósea radiográfica postreducción (AP, Stryker y West Point) para evidenciar lesiones óseas subdiagnosticadas inicialmente. Resultados: Se identificó lesión ósea en 26.1% de los individuos en la radiografía AP en un primer momento; de las personas que no mostraron fractura prerreducción, en 67.6% se encontró lesión ósea en las series radiográficas postreducción. Conclusiones: Se encontró un subdiagnóstico de 67.6% de las lesiones evidentes en la serie ósea postreducción en comparación con la radiografía AP inicial.

Abstract: Background: Shoulder dislocation is a common reason for admission in the emergency room. Its recurrence rate may be as high as 96% due to the associated bone lesions. The purpose of this study is to identify the underreporting of lesions comparing those identified in the initial X-ray with those identified in the post-reduction X-ray. Material and methods: X-rays of 46 patients with suspected anterior glenohumeral dislocation were assessed for diagnostic purposes and to identify the initial bone lesions. After patients had undergone reduction, post-reduction serial bone X-rays (AP, Stryker, Westpoint) were taken and analyzed looking for bone lesions that were initially missed. Results: Bone lesions were identified in 26.1% of the patients based on the initial AP X-rays. In 67.6% of the patients without a pre-reduction fracture a bone lesion was found in the post-reduction serial X-rays. Conclusions: The underreporting rate of bone lesions was 67.6% comparing the initial AP X-rays with the post-reduction serial bone X-rays.

Inestabilidad acromioclavicular. Tratamiento combinado artroscópico y miniinvasivo / Acromioclavicular instability: arthroscopic and mini-open combined treatment

Resumen: Introducción: el tratamiento quirúrgico de la luxación acromioclavicular es aún motivo de controversia. En esta publicación se describirá una técnica combinada en la que se realizó un primer tiempo artroscópico y un segundo tiempo con abordaje miniinvasivo. Material y métodos: 41 pacientes con luxación acromioclavicular grados III, IV y V. Para el seguimiento se incluyeron luxaciones agudas, crónicas y cirugías de revisión; se excluyeron pacientes con otras patologías de hombro, la edad promedio fue de 28.6 años. Los pacientes fueron evaluados con el score de UCLA Constant, la escala visual analógica para dolor preoperatorio y control radiológico para evaluar la estabilidad tanto en plano coronal como axial, osificaciones coracoclaviculares, signos de artrosis acromioclavicular y/o osteólisis distal de clavícula a los 6 y 12 meses postoperatorio. Resultados: se obtuvo un score de Constant preoperatorio de 41.3; 6 meses: 89.4; 12 meses: 92.3. El score de UCLA preoperatorio: 21.7; 6 meses: 29.1 y 12 meses: 31.4. VAS: 8.4; 2.3; 1.2. Hubo dos casos de relesión por trauma y un caso de insatisfacción estética de la cicatriz. En cuanto al examen radiológico se presentaron dos casos de pérdida de estabilidad y un caso de osteólisis distal de clavícula. Conclusión: la combinación de dos métodos de reducción, uno sintético y otro biológico, permitió una reconstrucción anatómica sólida, estable en plano coronal y axial con muy buenos resultados a mediano plazo.

Abstract: Introduction: The surgical treatment of acromioclavicular dislocation remains controversial. We describe herein a combined two-stage technique that includes an arthroscopic approach followed by a mini-invasive approach. Material and methods: 41 patients with acromioclavicular dislocation grades III, IV and V. Acute and chronic lesions and revision surgeries were included during the follow-up. Patients with other shoulder conditions were excluded. Mean age was 28.6 years. Patients were assessed preoperatively with the UCLA and Constant scores, and the pain visual analog scale. The 6- and 12-month postoperative evaluation included X-rays to assess coronal and axial stability, coracoclavicular ossifications, signs of acromioclavicular arthrosis and/or distal clavicular osteolysis. Results: The Constant scores were as follows: 41.3 preoperatively; 89.4 at 6 months; 92.3 at 12 months. The UCLA scores were as follows: 21.7 preoperatively; 29.1 at 6 months; 31.4 at 12 months. The VAS scores were 8.4, 2.3 and 1.2, for the same periods respectively. Two cases had repeated injury due to trauma and one case was dissatisfied with the cosmetic appearance of the scar. The X-ray assessment showed two cases of loss of stability and one case of distal clavicular osteolysis. Conclusion: The combination of two reduction methods, a synthetic one and a biological one allows for a solid anatomical reconstruction that is stable in the coronal and axial planes and good medium-term results.

Luxação acrômioclavicular / Acromioclavicular luxation

A articulação acrômio clavicular faz parte do conjunto anatômico que compõe o ombro. Ela é responsável pela estabilização e junção do esqueleto apendicular superior ao axial. Lesões traumáticas ou crônicas desta articulação levam a perda de função do membro superior. Lesões do tipo luxação nesta articulação representam 15% das luxações do ombro. A incidência desta patologia pode estar subestimada devido à parcela de pacientes que apresentam a patologia após o trauma e não procuram emergência médica ou consultas para diagnostico.

From the anatomical point of view, the acromioclavicular joint is part of the shoulder. It is responsible for the stabilization of the shoulder and it is the junction between the axial skeleton and the superior appendicular skeleton. Traumatic or chronic lesions of this joint can lead to important restriction of function. Acromioclavicular dislocation represents 15% of shoulder dislocations. The incidence of this pathology could be underestimated because a large parcel of patients do not seek emergencies for treatment at the time of the injury leaving the pathology undiagnosed.

Ipsilateral dislocation of the shoulder and elbow

Ipsilateral dislocation of shoulder and elbow joints is a rare injury. Only 2 such cases have been reported in the English literature. We report a case of a 35-year-old man involved in a road traffic accident under the influence of alcohol. He sustained posterior left elbow and anterior left shoulder dislocation with minimally displaced greater tuberosity fracture. He also had partial median nerve palsy. Under intramuscular pethidine and intravenous diazepam, close reduction of elbow followed by shoulder was carried out. At 2 months, median nerve function returned to normal. At 3 months, almost full elbow and shoulder joint movement returned. Although rare and complex, this ipsilateral injury can be treated conservatively

Assessment of anterior shoulder instability by CT arthrography

Computed tomography (CT) immediately after double-contrast shoulder arthrography was taken in twenty-two young male patients with anterior shoulder instability including recurrent dislocation and subluxation. This recently developed technique called CT arthrography can provide significant information about patients with glenohumeral instability which is difficult to obtain by conventional arthrography. Information about glenoid labrum pathology is useful for proper management of the shoulder with instability. Lesions identified in this study include anterior labral defects (attenuation, tear, displacement), anterior capsular distension and/or detachment, Hill-Sachs lesion, anterior glenoid rim compression fracture, and fracture of scapula. This article describes the method used in CT arthrography of the glenohumeral joint, reviews the normal cross-sectional anatomy, and emphasizes the importance of the application of CT arthrography in the shoulder disorder with instability. CT arthrography of the glenohumeral joint is easy to perform, is accurate, and has lower radiation dose than arthrotomography.