Knöcherne Begleitverletzungen nach Schulterluxation

[Shoulder dislocation in athletes]

BACKGROUND

Shoulder dislocation is a common injury in athletes. Surgical and non-surgical therapy options are still the subject of controversial debate.

STUDY AIM

This article presents important considerations for decision-making and current concepts for the therapy of shoulder dislocation in athletes.

METHODS

A selective literature search was carried out in PubMed.

RESULTS

Surgical and non-surgical therapy options are described in the literature without yet defining a gold standard.

CONCLUSION

Early surgical stabilization is currently recommended in young athletes. For decision-making numerous sport and patient-related factors need to be considered. Most athletes are able to return to the pre-injury level after surgical stabilization.

[Surgical treatment of posterior shoulder dislocation: importance of arthroscopy]

OBJECTIVE

Posterior dislocations of the shoulder represent a rare injury with frequently occurring soft tissue and/or bony concomitant lesions such as the reverse Hill-Sachs lesion and the dorsal labrum tear. For the combination of these injuries, no evidence-based therapeutic recommendations exist.

AIM OF STUDY

Reflecting on two clinical cases and the current literature data, options for the treatment of combined osseous and soft tissue injuries due to posterior dislocation of the shoulder are presented.

METHODS

We report two cases of fresh traumatic first-time posterior dislocations that were each explored arthroscopically and subsequently operated using an open technique. In the first case, we performed refixation of the labrum, followed by open osteosynthesis with bone substitution. Treatment of the second case included diagnostic arthroscopy and - after a frustrating attempt to elevate the defect in an arthroscopically assisted retrograde technique - open reconstruction of the humeral head with an allograft.

RESULTS

In both cases good clinical outcomes with Constant scores of 79 and 86 points at the 16- and 12-month follow-ups, respectively, were achieved. Radiologically complete integration of the used materials was found.

CONCLUSION

These cases show that for the operative treatment of fresh, traumatic posterior shoulder dislocation, it is useful to explore the joint arthroscopically to identify concomitant injuries of the labrum and if necessary treat them. The bony pathology of the humeral head can subsequently be addressed in an open technique, whereby the appropriate treatment should be chosen based on the size of the defect.

Evaluation of a treatment algorithm for acute traumatic osseous Bankart lesions resulting from first time dislocation of the shoulder with a two year follow-up

BACKGROUND

Studies dealing with acute osseous Bankart lesions and corresponding treatment strategies are rare. The purpose of this study is to analyze the results after applying our treatment algorithm for acute glenoid rim fractures caused by first time traumatic anterior shoulder dislocations.

METHODS

25 patients were included in this retrospective case series. All patients sustained a first time shoulder dislocation caused by ski or snowboard accidents. An osseous Bankart lesion was detected in all shoulders. Operative therapy was performed in patients with osseous defects of 5% or more, otherwise conservative therapy was initiated. Primary study outcome parameter was the Rowe score. Additionally, the outer rotation deficit and operative complications were analysed.

RESULTS

12 patients showed a defect size of less than 5% and were treated conservatively. The average lesion size was 2%. For these patients, the Rowe score was excellent in 58%, good in 25%, and moderate in 17% of patients. Three patients (25%) complained about a feeling of instability. 13 patients had a lesion size of more than 5%, average 15%, and were treated operatively. The Rowe score for this group was excellent in 54%, good in 31%, and moderate results in 15% of patients. One patient (8%) complained about a feeling of instability, without recurrent dislocations. There were no statistically significant differences between both study groups (ROWE score: p = 0.98).

CONCLUSIONS

Applying our treatment algorithm for acute osseous Bankart lesions consisting of a conservative strategy for small defect sizes and a surgical approach for medium-sized and large defects leads to encouraging mid-term results and a low rate of recurrent instability in active patients.