1
|
Alkaduhimi H, van den Bekerom MPJ, van Deurzen DFP. Step-by-Step Technique for Segmental Reconstruction of Reverse Hill-Sachs Lesions Using Homologous Osteochondral Allograft. Tech Hand Up Extrem Surg 2017; 21:60-66. [PMID: 28441305 DOI: 10.1097/bth.0000000000000151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Posterior shoulder dislocations are accompanied by high forces and can result in an anteromedial humeral head impression fracture called a reverse Hill-Sachs lesion. This reverse Hill-Sachs lesion can result in serious complications including posttraumatic osteoarthritis, posterior dislocations, osteonecrosis, persistent joint stiffness, and loss of shoulder function. Treatment is challenging and depends on the amount of bone loss. Several techniques have been reported to describe the surgical treatment of lesions larger than 20%. However, there is still limited evidence with regard to the optimal procedure. Favorable results have been reported by performing segmental reconstruction of the reverse Hill-Sachs lesion with bone allograft. Although the procedure of segmental reconstruction has been used in several studies, its technique has not yet been well described in detail. In this report we propose a step-by-step description of the technique how to perform a segmental reconstruction of a reverse Hill-Sachs defect.
Collapse
Affiliation(s)
- Hassanin Alkaduhimi
- Shoulder and Elbow Unit, Onze lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | | | | |
Collapse
|
2
|
Alkaduhimi H, van der Linde JA, Flipsen M, van Deurzen DFP, van den Bekerom MPJ. A systematic and technical guide on how to reduce a shoulder dislocation. Turk J Emerg Med 2016; 16:155-168. [PMID: 27995208 PMCID: PMC5154590 DOI: 10.1016/j.tjem.2016.09.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/18/2016] [Accepted: 09/26/2016] [Indexed: 01/19/2023] Open
Abstract
Objectives Our objective is to provide a systematic and technical guide on how to reduce a shoulder dislocation, based on techniques that have been described in literature for patients with anterior and posterior shoulder instability. Materials and methods A PubMed and EMBASE query was performed, screening all relevant literature on the closed reduction techniques. Studies regarding open reduction techniques and studies with fracture dislocations were excluded. Results In this study we give an overview of 23 different techniques for closed reduction and 17 modifications of these techniques. Discussion In this review article we present a complete overview of the techniques, that have been described in the literature for closed reduction for shoulder dislocations. This manuscript can be regarded as a clinical guide how to perform a closed reduction maneuver, including several technical tips and tricks to optimize the success rate and to avoid complications. Conclusion There are 23 different reduction techniques with 17 modifications of these techniques. Knowledge of the different techniques is highly important for a good reduction.
Collapse
Affiliation(s)
- H Alkaduhimi
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery OLVG, Amsterdam, The Netherlands
| | - J A van der Linde
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery OLVG, Amsterdam, The Netherlands
| | - M Flipsen
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery OLVG, Amsterdam, The Netherlands
| | - D F P van Deurzen
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery OLVG, Amsterdam, The Netherlands
| | - M P J van den Bekerom
- Shoulder and Elbow Unit, Joint Research, Department of Orthopaedic Surgery OLVG, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Abstract
Shoulder dislocations are seen on a daily basis in Accident and Emergency departments. The vast majority of these injuries are acute, traumatic dislocations and occur in the anterior direction. The clinical and radiological features of an anterior dislocation are fairly typical and the diagnosis is usually reached quickly. The sooner the joint is reduced, the easier will be required to overcome the muscle spasm. There is still no consensus as to the best way to manage these injuries in the emergency setting. We summarise the types of acute glenohumeral dislocations and the commonly used reduction methods for anterior dislocations. The literature about different analgesic and sedative options is also reviewed. Occasionally, a combination of sedatives and analgesics and more than one reduction technique are employed in order to avoid manipulation of the dislocated shoulder under general anaesthetic.
Collapse
Affiliation(s)
- T. Christofi
- Accident & Emergency Department, University College Hospital, UCL Hospitals NHS Foundation Trust, London, UK,
| | - A. Kallis
- Accident & Emergency Department, University College Hospital, UCL Hospitals NHS Foundation Trust, London, UK
| | - D.A. Raptis
- Department of Surgery, University College Hospital, UCL Hospitals NHS Foundation Trust, London, UK
| | - M. Rowland
- Accident & Emergency Department, University College Hospital, UCL Hospitals NHS Foundation Trust, London, UK
| | - J. Ryan
- Accident & Emergency Department, University College Hospital, UCL Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
4
|
Sandmann GH, Siebenlist S, Imhoff FB, Ahrens P, Neumaier M, Freude T, Biberthaler P. Balloon-guided inflation osteoplasty in the treatment of Hill-Sachs lesions of the humeral head: case report of a new technique. Patient Saf Surg 2016; 10:4. [PMID: 26839592 PMCID: PMC4736246 DOI: 10.1186/s13037-016-0092-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 01/17/2016] [Indexed: 11/20/2022] Open
Abstract
Background The use of the extra-vertebral balloon osteoplasty is increasing and in the meanwhile it has become a safe surgical technique in the treatment of tibial head, distal radius and calcaneus fractures. In addition, we already could show in a biomechanical setup that the balloon osteoplasty might be a safe tool for reduction in the treatment of Hill-Sachs lesions, but clinical application has not been performed so far. Case presentation We report the case of a 53 year- old male patient who was referred to our Trauma department (level I trauma center) after the first manifestation of a posterior shoulder dislocation due to an epileptic seizure, originated in a- up to this date unknown -glioblastoma. After closed reduction of the dislocated shoulder the X-ray showed a subcapital fracture of the proximal humerus with a large reversed Hill-Sachs lesion. We performed an open surgery via a deltoideopectoral approach and balloon osteoplasty was used to reduce the impression fracture (Hill-Sachs lesion) before fixing the fracture with a locking plate. In the post-operative CT scan we could show an anatomical reduction of the Hill-Sachs lesion. At the follow-up examination one year after surgery the patient reached full range of motion and stated no re-dislocation of the shoulder nor instability or pain. Conclusion The reduction of an impressed humeral head fracture by use of balloon osteoplasty is a safe technique. This technique could be a new option in the treatment of Hill-Sachs lesions and might be an alternative to well known standard procedures like the remplissage or tendon transfers without affecting rotation.
Collapse
Affiliation(s)
- Gunther H Sandmann
- Department of Traumatology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675 Munich, Germany ; Department of Traumatology, Eberhard-Karls-Universitaet, Schnarrenbergstr. 9, D-72076 Tuebingen, Germany
| | - Sebastian Siebenlist
- Department of Traumatology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675 Munich, Germany ; Department of Orthopaedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, D- 81675 Munich, Germany
| | - Florian B Imhoff
- Department of Traumatology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675 Munich, Germany ; Department of Orthopaedic Surgery, Krankenhaus Barmherzige Brueder, Romanstr. 93, D-80639 Munich, Germany
| | - Philipp Ahrens
- Department of Traumatology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675 Munich, Germany ; Department of Orthopaedic Surgery, Klinikum Mittelbaden, Lilienmattstr. 5, D-76530 Baden-Baden, Germany
| | - Markus Neumaier
- Department of Traumatology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675 Munich, Germany
| | - Thomas Freude
- Department of Traumatology, Eberhard-Karls-Universitaet, Schnarrenbergstr. 9, D-72076 Tuebingen, Germany
| | - Peter Biberthaler
- Department of Traumatology, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str. 22, D-81675 Munich, Germany
| |
Collapse
|
5
|
Neglected posterior dislocation of the shoulder: A systematic literature review. J Orthop Translat 2015; 3:89-94. [PMID: 30035045 PMCID: PMC5982360 DOI: 10.1016/j.jot.2015.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/01/2015] [Accepted: 02/25/2015] [Indexed: 12/12/2022] Open
Abstract
Posterior dislocation of the shoulder (PSD) is a rare injury; the diagnosis is often missed on initial examination. We present a systematic review of the current literature and discuss the key of the diagnosis of PSD. We searched the MEDLINE, PubMed, EMBASE, MD Consult, and the Cochrane Controlled Trial Register databases for the articles according to our eligibility criteria. Finally, 53 articles were included in our systematic review. There were 242 shoulders in 205 patients. In total, in the initial assessment with anteroposterior radiographs in 166 cases, only 19 (11.4%) cases confirmed the right diagnosis. When anteroposterior combined with axillary or Y view radiographs or computed tomography were present as the initial assessments in 36 cases, the diagnoses were made correctly and timely (100%). When axillary or Y view radiographs or computed tomography were taken subsequently, the diagnosis was confirmed in all 205 patients.
Collapse
|
6
|
Jacquot F, Costil V, Werther JR, Atchabahian A, Sautet A, Feron JM, Doursounian L. Balloon treatment of posterior shoulder dislocation with reverse Hill-Sachs injury: description of a new technique. INTERNATIONAL ORTHOPAEDICS 2013; 37:1291-5. [PMID: 23568144 DOI: 10.1007/s00264-013-1877-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE Posterior shoulder dislocations are rare, and are usually the result of seizures. Anterior defects of the humeral head known as "reverse Hill-Sachs lesions" may increase the risk of recurrent dislocation and are difficult to treat. We developed a percutaneous technique for reduction of the dislocation or reduction of the anterior impaction fracture, using percutaneous balloon dilatation and cement fixation. METHODS From 2009 to 2012, three patients aged 33, 72 and 75 years were admitted to our institution with a posterior shoulder dislocation showing an anterior "reverse Hill-Sachs" impaction fracture. One case was bilateral (four fractures). Patients were operated upon in the sitting position; the humeral head was stabilised by external fixator pins during balloon inflation. Reduction or filling of the defect was obtained in all cases. All patients were followed up and two patients (three fractures) were examined after one year by an independent observer. The clinical results were assessed using the Constant score and the RAND-36 physical components score. A computed tomography (CT) scan was obtained in all patients before and after the operation and at the latest follow-up. RESULTS At three months postoperatively, all patients had resumed work or daily life activities with no limitation. The mean Constant score was 71 and RAND-36 score was 85.5. After one year, the mean Constant score was 73 and the RAND-36 score was 86.4 for the two patients who had sufficient follow-up. On the postoperative radiograph and CT scan, sphericity of the humeral head was restored, and the reverse Hill-Sachs impaction was filled or reduced in all cases. There was no recurrent dislocation. CONCLUSION Based on this small series, we believe that this technique should be added to our current armamentarium for posterior shoulder dislocations showing a deep impaction fracture of the humeral head that are at risk for recurrent dislocation.
Collapse
|
7
|
Beck S, Chilstrom M. Point-of-care ultrasound diagnosis and treatment of posterior shoulder dislocation. Am J Emerg Med 2013; 31:449.e3-5. [DOI: 10.1016/j.ajem.2012.06.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 06/23/2012] [Indexed: 11/30/2022] Open
|
8
|
Abstract
OBJECTIVE Posterior shoulder dislocations are rare and often missed. Classically associated with seizures, very little is known about the incidence and type of associated injuries. Unfortunately, the majority of the literature consists of incidental reports or small case series. Our goal was to increase the strength of available data by performing a systematic review. DATA SOURCES We searched EMBASE and PubMed for the terms "posterior shoulder dislocation." Our inclusion criteria were articles in either English or French with the words "posterior" and "dislocation" in the abstract or title. All reports of chronic cases or instability as well as those without patient information were excluded. Data regarding demographics, etiology, investigations, associated injuries, treatments, and outcomes were extracted. All data were analyzed by using SPSS 18.0 (IBM, Chicago, IL). RESULTS A total of 766 articles were found of which 108 were retained for analysis. A total of 475 patients (543 shoulders) were compiled. Seizures were reported in 34% of cases. A majority of dislocations (65%) had associated injuries. Fracture was most common followed by reverse Hill-Sachs and cuff tears. In the absence of fracture or reverse Hill-Sachs injury, the risk of cuff tear increased nearly fivefold (odds ratio, 4.6; P = 0.016). CONCLUSION Our results suggest the amount of associated injuries related to posterior shoulder dislocation is far greater than thought. We propose an investigation algorithm for acute posterior shoulder dislocations.
Collapse
|
9
|
Closed reduction of bilateral posterior shoulder dislocation with medium impression defect of the humeral head: a case report and review of its treatment. Case Rep Med 2011; 2011:124581. [PMID: 22162694 PMCID: PMC3227387 DOI: 10.1155/2011/124581] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Revised: 09/19/2011] [Accepted: 09/19/2011] [Indexed: 11/29/2022] Open
Abstract
Bilateral dislocation of the shoulder is a rare injury. The main causes are electrical shock, extreme trauma, and epilepsy. A 25-year-old athletic-body man had sustained bilateral shoulder pain and restricted external rotation following electrical shock for five days. Although articular surface damage was about 50% in the right side and 30% in the left, it could be managed successfully by close reduction without pinning. During one-year follow-up, no recurrent dislocation or limitation of motion was seen. Closed management of medium size defect of the humeral head after posterior dislocation can be performed in cooperative and especially muscular patients.
Collapse
|
10
|
Alta TDW, Willems WJ. Bilateral posterior fracture-dislocation of the shoulder managed by allograft reconstruction of the segmental defect: report of two cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2008. [DOI: 10.1007/s00590-008-0316-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
11
|
Iosifidis MI, Giannoulis I, Traios S, Giantsis G. Simultaneous bilateral posterior dislocation of the shoulder: diagnostic problems and management. A case report. Knee Surg Sports Traumatol Arthrosc 2006; 14:766-70. [PMID: 16501951 DOI: 10.1007/s00167-006-0066-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2005] [Accepted: 09/13/2005] [Indexed: 01/14/2023]
Abstract
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.
Collapse
|
12
|
Ozçelik A, Dinçer M, Cetinkanat H. Recurrent bilateral dislocation of the shoulders due to nocturnal hypoglycemia: a case report. Diabetes Res Clin Pract 2006; 71:353-5. [PMID: 16125271 DOI: 10.1016/j.diabres.2005.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Accepted: 07/15/2005] [Indexed: 11/17/2022]
Abstract
A 20-year-old male was admitted to emergency room with convulsion. He had insulin-dependent diabetes mellitus for 8 years. He had suffered nocturnal hypoglycemia after strenuous exercise without additional calories. After recovery, the patient complained of bilateral anterior shoulder dislocation. Patient's history revealed another episode of bilateral shoulder dislocations after an hypoglycemic convulsion 3 years ago.
Collapse
Affiliation(s)
- Abdurrahman Ozçelik
- Department of Orthopaedics, Osmangazi University Hospital, Meşelik 26480, Eskişehir, Turkey.
| | | | | |
Collapse
|
13
|
Cyffka R, Jackisch T, Lein T, Bonnaire F. [Simultaneous bilateral ventral and dorsal shoulder dislocation following an epileptic convulsion--a rare combination of injuries]. Unfallchirurg 2005; 108:327-31. [PMID: 15856129 DOI: 10.1007/s00113-004-0878-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We report about a 29 year old male patient who had a simultaneous bilateral ventral and dorsal shoulder dislocation. The dislocation happened during a first incident of an epileptic convulsion, previously not diagnosed. On the right shoulder following a closed reduction manoeuvre a dislocation fracture was seen. It needed operative open reduction and fixation with angular stable plate osteosynthesis. The locked dorsal shoulder dislocation on the left was operated dorsally secondary via a dorsal approach. In a first step the reduction was carried out and in the same intervention the humeral head defect was lifted and supported in a closed technique under radiographic control.6 months postoperatively the patient was free of pain in both shoulder joints. The range of motion was unimpeded on the left and only with slight deficits in abduction and anteversion on the right. The diagnostics and the treatment strategy for this rare injury combination are described critically in this paper.
Collapse
Affiliation(s)
- R Cyffka
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Klinikum Dresden.
| | | | | | | |
Collapse
|