Evaluation of Clinical & Functional Outcomes Bristow Latarjet Procedure in the Management of Recurrent Anterior Shoulder Dislocation

Background: Glenohumeral joint is highly susceptible to dislocation due to its wide range of movements. Recurrent anterior shoulder dislocations are common in young adults. The Bristow Latarjet procedure is one of the effective techniques for the treatment of recurrent anterior shoulder dislocation. This study aimed to assess the clinical and functional outcome of the Bristow Latarjet procedure in the management of recurrent anterior shoulder dislocation. Material & Methods: This prospective interventional study was conducted in the Department of Orthopaedic Surgery, BSMMU, from October 2017 to September 2019. Within this period, a total of 40 cases of recurrent anterior shoulder dislocation that meet inclusion criteria were taken as a sample. Patients were evaluated both pre and postoperatively for functional outcomes according to Rowe’s score for instability. A purposive non-randomized sampling technique was used in this study. All the data were compiled and sorted properly and the quantitative data were analyzed statistically by using Statistical Package for Social Science (SPSS-25). The results were expressed as frequency, percentage and mean ± SD. Paired Student’s‘t’ test was performed to compare pre and final postoperative follow-up. The level of significance was calculated at a confidence interval of 95% and p-value <0.05. Results: : In this study age of the patient ranged from 18-40 years and the mean age was 28.2±6.3. 29(72.5). Surgery was done within 4-6 months of the first dislocation in 5 patients, within 6-12 months in 21 patients and after 12 months in 14 patients. The mean (±SD) Rowe score for instability was significantly (p<0.001) higher 6 months after the Bristow Latarjet procedure at 91.87(±9.00) in comparison to preoperative periods 52.62(±18.40). Results were excellent in 32(80%), good in 4(10%), fair in 3(7.5%) and poor in 1(2.5%) patients. 36(90%) patients were in the satisfactory group and only 4(10%) in the unsatisfactory group. Only 1(2.5%) patient developed screw migration, 2(5%) patients developed subluxation, and 1(2.5%) patient developed postoperative arthritis. Conclusion: It can be concluded that the Bristow-Latarjet procedure is a very effective and safe procedure with reduced complications, presenting very satisfactory functional results in the treatment of recurrent anterior shoulder dislocation.

Research progress in biomechanics of Bristow-Latarjet procedure for anterior shoulder dislocation / 中国修复重建外科杂志

OBJECTIVE@#To review the research progress of the biomechanical study of the Bristow-Latarjet procedure for anterior shoulder dislocation.@*METHODS@#The related biomechanical literature of Bristow-Latarjet procedure for anterior shoulder dislocation was extensively reviewed and summarized.@*RESULTS@#The current literature suggests that when performing Bristow-Latarjet procedure, care should be taken to fix the bone block edge flush with the glenoid in the sagittal plane in the direction where the rupture of the joint capsule occurs. If traditional screw fixation is used, a double-cortical screw fixation should be applied, while details such as screw material have less influence on the biomechanical characteristics. Cortical button fixation is slightly inferior to screws in terms of biomechanical performance. The most frequent site of postoperative bone resorption is the proximal-medial part of the bone block, and the cause of bone resorption at this site may be related to the stress shielding caused by the screw.@*CONCLUSION@#There is no detailed standardized guidance for bone block fixation. The optimal clinical treatment plan for different degrees of injury, the factors influencing postoperative bone healing and remodeling, and the postoperative osteoarticular surface pressure still need to be further clarified by high-quality biomechanical studies.

CT localization on suprascapular nerve and clinical application value in arthroscopic Bristow-Latarjet / 中国组织工程研究

BACKGROUND: The Bristow-Lataijet technique is a reliable treatment for recurrent anterior shoulder instability. However, it as been reported 1.6% of patients suffering nerve injury. Thereafter, the all-arthroscopic Latarjet procedure has been gaining popularity, but the surgeon is unable to palpate the nerves, and their localization, so protection is a difficulty. OBJECTIVE: To investigate the CT localization of suprascapular nerve on the posterosuperior scapular neck, and to improve the safety and quality in Bristow-Latarjet surgery. METHODS: This study was carried out on 12 normal formalin fixed adult cadaveric upper limb specimens (8 males and 4 females). The study was in accordance with the ethical requirements of Dongguan Hospital of Traditional Chinese Medicine. The nerve trunk and branches were marked with developing lines to examine the position and course of nerve on the posterosuperior scapular neck. CT localization was used to measure the distance, angle and height ratio to glenoid from the superior pole of scapula, spinoglenoid notch, the entry point of outermost nerve branch to anterior and posterior margin of the glenoid, through internally and externally rotating 45 degrees of should joints. The data were statistically analyzed. RESULTS AND CONCLUSION: (1) Pearson correlation analysis: The height of glenoid was positively correlated with the distance from the spinoglenoid notch and entrance point to the articular surface. (2) Comparison between internal and external rotation 45 degrees: Distance of superior pole of scapula and angles showed no significant difference (all P > 0.05). There were significant differences in the distance and angle in the spinoglenoid notch (all P 0.05). There were significant differences in distance, angle, and height ratio at entrance point (all P < 0.01), suggesting that external rotation had larger angle and safer range of distance than internal rotation. In the position of internal and external rotation 45 degrees, the distance, angle and height ratio of spinoglenoid notch and entrance point showed significant differences (P < 0.01), indicating that compared with spinoglenoid notch, the angle between entrance point and articular surface was smaller, the distance from entrance point to articular surface was shorter, and the height ratio was higher. (4) Therefore, external rotation is recommended in the case of internal fixation of the bony tunnel for the posterior glenoid so as to reduce the incidence of nerve injury.

Pérdidas óseas de la glenoides en las inestabilidades anteriores recurrentes del hombro / Shoulder recurrent instability associated with glenoid bone loss

Introducción: El objetivo de este trabajo es destacar la frecuencia e importancia de las perdidas óseas glenoideas que no fueron consideradas por mucho tiempo y las posibilidades terapéuticas teniendo en cuenta dicha lesión. Presentar nuestra experiencia en el tratamiento estandarizado de las luxaciones recurrentes anteriores del hombro, vírgenes de cirugía previa, enfatizando en las pérdidas óseas antero inferiores del reborde glenoideo. Objetivo: Determinar la importancia de las pérdidas óseas de la glenoides en inestabilidades recurrentes de hombro. Material y Métodos: Se estudiaron 22 pacientes sin tratamiento quirúrgico previo por la patología descripta, con edades entre 18 y 45 años, con un claro predominio del sexo masculino (proporción 8 a 2). Se operaron con la técnica abierta modificada de Bristow Latarjet. La base de nuestro enfoque es la correcta selección de los pacientes, la técnica aplicada y el programa de rehabilitación precoz. La serie la consideramos de homogeneidad aceptable entre sus integrantes, así como los procedimientos quirúrgicos y la evaluación efectuada. Resultados: Se realizó una evaluación retrospectiva objetiva y subjetiva de los resultados a los dos años en una cohorte de 22 pacientes. Se valoraron de acuerdo con exámenes físico, imagenológico y de resultados, por cuestionarios completados por médicos y pacientes con el Score de Constant y de la ASES. Las cifras obtenidas fueron: 86% presentó hombros estables, indoloros o con poco dolor con una mínima pérdida de la rotación externa considerada entre los 6 y 8°, con limitaciones menores para las actividades por encima de la cabeza. No observamos re luxaciones o problemas con la consolidación de la coracoides ni tampoco artrosis temprana. Los consideramos resultados excelentes o buenos. Los mismos encuentran su principal objeción en la falta de verificaciones a largo plazo, que es cuando puede observarse la aparición de artrosis secundaria...

Background: Treatment of recurrent anterior shoulder instability isin continuous development. This disabling condition requires allthe possible knowledge, skills and broad experience to be solved. The purpose of this study was emphasized the importance of the glenoid bone loss and to verify th e hypothesis that the open coracoid transfer as described by Bristow Latarjet is a highly successful for treating recurrent glenohumeral instability associated with glenoid bone losses.Objectives: To determine glenoid bone losses importance inshoulder recurrent instability. Material and Methods:We selected a cohort of 22 patients, ages between 18 and 45 y.o. with predominance of males over females (rate 8 to 2), with recurrent anterior glenohumeral instability. All of them were treated with open Bristow Latarjet technique. We considered there is acceptable homogeneity in this cohort as wellas in the surgical procedure and the final evaluation methods.Results: Our results were obtained with an average outcome of 2 years. We perform physical examination, images screening, surveys between patients performed by physicians, and the Constan and ASES scores. 85% showed a stable shoulder, painless, with minimal external rotation loss (between 6 and 8...