Osseous Defects Seen in Patients with Anterior Shoulder Instability

Shoulder surgeons need to be aware of the critical size of the glenoid or humeral osseous defects seen in patients with anterior shoulder instability, since the considerable size of osseous defect is reported to cause postoperative instability. Biomechanical studies have identified the size of the osseous defect which affects stability. Since engagement always occurs between a Hill-Sachs lesion and the glenoid rim, when considering the critical size of the Hill-Sachs lesion, we have to simultaneously consider the size of the glenoid osseous defect. With the newly developed concept of the glenoid track, we are able to evaluate whether a large Hill-Sachs lesion is an "on-track" or "off-track" lesion, and to consider both osseous defects together. In case of an off-track Hill-Sachs lesion, if the glenoid defect is less than 25%, no treatment is required. In this case, the Latarjet procedure or arthroscopic remplissage procedure can be a treatment option. However, if the glenoid defect is more than 25%, treatment such as bone grafting is required. This will convert an off-track lesion to an on-track lesion. After the bone graft or Latarjet procedure, if the Hill-Sachs lesion persists as off-track, then further treatment is necessitated. In case with an on-track Hill-Sachs lesion and a less than 25% glenoid defect, arthroscopic Bankart repair alone is enough.

Treatment of recurrent anterior dislocations of shoulder by Laterjet-Bristow operation: an experience.

Shoulder dislocation is common problem in orthopaedics. Management of recurrent shoulder dislocation is painstaking with different surgical procedures having varying outcomes. Laterjet-Bristow procedure provides stability and good functional outcome in Rowe scale and long term patient satisfaction. This is an observational prospective study carried out at two different tertiary care centers at Nepal and Pakistan using the same protocol. Habitual and pathological recurrent dislocations were excluded and all the recurrent dislocation of shoulder following initial traumatic anterior dislocation was included in this study. Standard Laterjet-Bristow operation was done and followed up for average of 27 months. Functional evaluation was done using Rowe score and graded as excellent, good, fair and poor. There were 12 men and 9 women with the mean ages of 23.4 years. At 12 months, 11 patients had fair result and seven patients had good result. At two years only three had fair result, 15 had good result and three patients had excellent result. Only three patients had poor result at one year while none had poor result at two year. The mean loss of external rotation in operated shoulder at one year was 24.33 degrees which decreased to 21.2 degrees at the end of second year. There was no restriction of external rotation in three patients at both yearly follow-ups while 18 patients had restriction in the range 10-30 degrees. Laterjet-Bristow can be the procedure of choice for surgical treatment of recurrent traumatic anterior dislocation and also as a salvage surgery for failed cases from other types of procedures. The only shortcoming of this procedure was some limitation in external rotation and minor loss in muscle power of that shoulder.

Resultados de la fijación artroscópica del labrum en la luxación recidivante del hombro / Results of arthroscopic fixation of the labrum in recurrent dislocation of the shoulder

En un estudio de tratamiento artroscópico de luxación recidivante del hombro que incluyó 15 casos, se demostró en todos ellos desinserción del labrum anterior, el procedimiento quirúrgico requiere de entrenamiento especial y tiene una morbilidad mínima, reintegrándose los pacientes a su vida normal a las cuatro semanas de postoperados, pues no se usa inmovilización. Se logró evitar nuevas luxaciones en 93 por ciento de los casos y el único caso de recidiva obedeció a haber realizado la fijación en un paciente con crisis convulsivas. Se concluye que el primer paso quirúrgico en el primer paso de esta patología debe ser la artroscopía.

Tratamiento quirúrgico de la inestabilidad glenohumeral multidireccional / Surgical treatment for multidirectional instability of the shoulder

Ensayo clínico realizado entre 1987 y 1992; la muestra estuvo conformada por 22 pacientes que reunieron los criterios de inclusión (inestabilidad glenohumeral multidireccional), las variables de estudios fueron: signos de hiperelasticidad, de inestabilidad glenohumeral, y de alamiento escapular. En todos se realizó tratamiento quirúrgico, y posteriormente llevaron a cabo tratamiento de rehabilitación. Se estudiaron 22 pacientes, 14 de sexo masculino y 8 de sexo femenino; rango de edad de 16 a 35 años; todos mostraron signos de alamiento escapular y en 20 se identificaron signos de alamiento escapular y en 20 se identificaron signos positivos de hiperelasticidad e inestabilidad anterior e inferior. Se mostró negativización de los signos clínicos a las 12 semanas del postoperatorio y hubo reintegración a las actividades deportivas al 5º mes de la cirugía. La técnica quirúrgica utilizada es un procedimiento sencillo, que no limita la movilidad articular y permite una rápida reintegración a las actividades ocupacionales y deportivas. No se registraron complicaciones

Fisiopatología de la luxación recidivante de hombro: operación de Bristow / Physiopathology of the shoulder recurrent luxation: Bristow procedure

Se evalúa un grupo de 15 pacientes con luxación recidivante de hombro tratados quirúrgicamente. La técnica operatoria fue la de Bristow, descripta por Helfet con las modificaciones impuestas por Latarjet. Los resultados, considerados como satisfactorios, muestran la ausencia de recidivas y de limitaciones funcionales. En función de las variaciones anatómicas y de algunos aspectos biomecánicos, se considera necesaria la transferencia del coracobiceps, no sólo como un medio de contención pasiva, sino como un elemento activo y dinámico que reforzará las estructuras debilitadas