Cases reported "Shoulder Dislocation"

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1/6. Bilateral posterior fracture dislocation of the shoulders following seizure.

    Bilateral posterior fracture dislocation is a rare injury known to be associated with seizures. Convulsion was found to be the cause of fracture dislocation in 78% of the cases reported. The mechanism of injury was described by Shaw in 1971. The management depends largely on the severity of the injury. In many cases reported, the fracture was a large compression defect in the anteromedial aspect of the articular surface of the humeral head. It has been suggested that for defects that involve less than 20% of the articular surface closed reduction can be attempted. Rush nail or percutaneous K wires can be used to maintain reduction. Open reduction is necessary for defects that are involving 20-40% of the surface. The aim in these cases is to reconstruct the proximal humerus if possible by the use of internal fixation. If reconstruction is not feasible, a modified McLaughlin procedure can be used to prevent chronic instability of the shoulder. This procedure involves re-implanting the subscapularis tendon into the defect. Reconstructing fractures that involve more than 40% of the articular surface or 4-part fracture is not usually successful. These fractures are associated with a high the risk of avascular necrosis. Hemi-arthroplasty or total shoulder replacement is generally regarded as better option as they offer rapid recovery and eliminate the possibility of multiple procedures if fixation fails.
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ranking = 1
keywords = anteromedial
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2/6. humeral head impression fracture in acute posterior shoulder dislocation: new surgical technique.

    Posterior shoulder dislocation with humeral head impression fracture is rare and its early diagnosis and treatment remain a challenge for the orthopaedic surgeon. Although literature describes several surgical options, most are based on the detachment of the subscapularis or on more complex techniques that change the humeral joint anatomy even more. This report describes a new operative technique that is only slightly invasive, where the depressed chondral surface is raised to regain a normal articular contour. The chondral surface is supported by an interference biabsorbable screw and the insertion of the subscapularis tendon is left intact. Two male patients with an acute shoulder posterior dislocation associated with anteromedial impression fracture of about 40 and 50%, respectively, of the articular humeral shape were treated in our department. The average follow-up was 26 months where plain X-ray and CT scan showed an anatomical humeral surface free from signs of arthritis or necrosis. Functional results were excellent in both cases. This new technique is easy, less invasive than others and ensures a stable cartilage and subchondral support without the use of grafts.
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ranking = 1
keywords = anteromedial
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3/6. Simultaneous bilateral posterior dislocation of the shoulder: diagnostic problems and management. A case report.

    We present the case of a patient who sustained simultaneous bilateral posterior dislocation of the shoulder after a possible epileptic fit. The confirmation of the diagnosis was reached only by a computed tomography (CT) scan, after the clinical suspicion. Under general anesthesia, close reduction of both shoulder dislocations was done. Posterior dislocation of the shoulder-especially the bilateral one-is very rare. When the history describes an electric shock or convulsive seizure, any shoulder injury demands a careful clinical and radiological evaluation. It is usually associated with reverse Hill-Sachs lesion (an impression defect of the anteromedial aspect of the humeral head), in which the size determines the treatment options.
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ranking = 1
keywords = anteromedial
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4/6. Management of posterior fracture-dislocations of the shoulder.

    Posterior fracture-dislocation of the shoulder is rare. Comprehensive treatment guidelines for posterior fracture-dislocation of the shoulder with fracture of the humeral head have not been previously published. Although open reduction and internal fixation of the proximal humerus for posterior fracture-dislocation has been reported in several series, the successful reconstruction of the articular surface by rigid internal fixation of a large osteochondral fragment has not been reported. This paper describes two cases of posterior fracture-dislocation of the shoulder with a substantial defect of the anteromedial humeral head resulting from the cleavage of a large osteochondral fragment. Preoperative computed axial tomographic (CAT) scanning of the injured shoulders helped in operative planning by precisely defining the extent of the articular injury. Accurate reconstruction of the articular surface restored joint stability and gave excellent clinical results. Large humeral head osteochondral fracture fragments require accurate reduction and internal fixation.
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ranking = 1
keywords = anteromedial
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5/6. Posterior dislocation of the shoulder with a large anteromedial defect of the head of the humerus. A case report.

    A new surgical technique for treating a posterior dislocation of the shoulder with a large anteromedial defect of the humeral head is described; it can be applied to those very severe dislocations that might otherwise be considered to need replacement or arthrodesis. A transverse osteotomy below the surgical neck of the humerus with lateral rotation of the head into anteversion limits medial rotation and this prevents the edge of the defect impinging on the posterior edge of the glenoid to cause redislocation.
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ranking = 5
keywords = anteromedial
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6/6. Acute posterior fracture dislocations of the shoulder treated with the Neer modification of the McLaughlin procedure.

    Posterior dislocation of the shoulder may be associated with an anteromedial impaction fracture rendering the shoulder unstable in internal rotation. The modified McLaughlin procedure as described by Neer involves transplanting the lesser tuberosity with the attached subscapularis tendon into the anteromedial defect. We have used this procedure acutely (from the day of injury to 10 days postinjury) in seven shoulders. All patients were unstable in internal rotation and had an anteromedial impaction fracture occupying 25-40% of the articular surface. This technique provides good stability, enables immediate active range of motion, and allows the patient to rapidly return to activities of daily living.
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ranking = 3
keywords = anteromedial
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