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Safouen BB, Khalil H, Ahmed M, Mehdi M, Hassen M, Mondher M. Obturator hip dislocation associated with contralateral luxatio erecta humeri: An unusual traumatic association (case report). Int J Surg Case Rep 2024; 117:109510. [PMID: 38471210 PMCID: PMC10945161 DOI: 10.1016/j.ijscr.2024.109510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Obturator hip dislocation and luxatio erecta humeri are two extremely rare injuries. We are reporting a very rare case that involves the association of these two injuries. CASE PRESENTATION We reported the case of a 34-year-old male who was a victim of a high-energy road accident. Initial examinations showed a right obturator dislocation associated with a left luxatio erecta humeri without vascular-nervous complication. Further examinations have ruled out life-threatening injuries. A closed reduction for both joints has been performed under general anesthesia less than 6 h following the trauma. Postoperative examination showed two congruent joints. Functional treatment has been implemented. Weight-bearing was permitted after 6 weeks, and physical rehabilitation of the shoulder was initiated 3 weeks after the trauma. Last examination (20 months after trauma) showed a painless two-joint with a full range of motion. There was no sign of shoulder instability, and radiographs showed no signs of avascular necrosis of the femoral head. CLINICAL DISCUSSION Both injuries are two rare orthopedic emergencies that require prompt diagnosis and immediate reductions. CONCLUSIONS A good outcome can be expected if functional treatment is applied after prompt closed reduction. Hence, regular monitoring is required to detect complications such as avascular necrosis of the femoral head for the hip and signs of instability for the shoulder.
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Affiliation(s)
- Ben Brahim Safouen
- Adults' Orthopedic Department of Mohammed Kassab National Institute of Orthopedic, Tunisia.
| | - Habboubi Khalil
- Adults' Orthopedic Department of Mohammed Kassab National Institute of Orthopedic, Tunisia
| | - Mzid Ahmed
- Adults' Orthopedic Department of Mohammed Kassab National Institute of Orthopedic, Tunisia
| | - Meddeb Mehdi
- Adults' Orthopedic Department of Mohammed Kassab National Institute of Orthopedic, Tunisia
| | - Makhlouf Hassen
- Adults' Orthopedic Department of Mohammed Kassab National Institute of Orthopedic, Tunisia
| | - Mestiri Mondher
- Adults' Orthopedic Department of Mohammed Kassab National Institute of Orthopedic, Tunisia
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Ntourantonis D, Mousafeiris V, Pantazis K, Iliopoulos I, Kaspiris A, Korovessis P, Lianou I. The 'Holy Grail' of shoulder dislocations: a systematic review on traumatic bilateral luxatio erecta; is it in reality a once-in-a-lifetime experience for an orthopaedic surgeon? Arch Orthop Trauma Surg 2024; 144:205-217. [PMID: 37776337 PMCID: PMC10774214 DOI: 10.1007/s00402-023-05047-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/26/2023] [Indexed: 10/02/2023]
Abstract
INTRODUCTION Even though shoulder dislocation is thought to be the most common dislocation treated in the Emergency Department, inferior ones, known as Luxatio Erecta, comprise only 0.5% of them. Taking into consideration the rareness of unilateral Luxatio Erecta, bilateral cases should be even fewer. The purpose of this paper is to identify the reported number of cases of Traumatic Bilateral Luxatio Erecta in the literature over the last 100 years and to summarize the mechanism of injury, the initial management, and the complications of these patients. MATERIALS AND METHODS We performed a systematic review of the literature regarding Traumatic Bilateral Luxatio Erecta. All articles published until 31st of December 2022 in PubMed and Google Scholar databases were searched using the terms "luxatio erecta", 'inferior dislocation", and "bilateral". RESULTS Eighty-two articles were retrieved from PubMed and Google Scholar search. Forty-four of them were initially included in our review. Six additional articles meeting the inclusion criteria were found from cross-references. CONCLUSION The presence of this injury is extremely rare with only 51 cases in the literature. The incidence of concomitant injuries and complications seems to be extremely high and neurological deficits were detected on 42.8% of patients with Bilateral Luxatio Erecta. To our knowledge, this is the first systematic review of the literature regarding Traumatic Bilateral Luxatio Erecta that includes articles not only in English, a fact that provides more reliability on the estimation of the real number of cases of this rare injury compared to any other review on this subject to date.
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Affiliation(s)
- Dimitrios Ntourantonis
- Emergency Department, University Hospital of Patras, Patras, Greece.
- Department of Medicine, School of Health Sciences, University of Patras, Patras, Greece.
| | | | | | | | - Angelos Kaspiris
- Laboratory of Molecular Pharmacology, Department of Pharmacy, School of Health Sciences, University of Patras, Patras, Greece
| | | | - Ioanna Lianou
- Department of Orthopaedics, General Hospital of Patras, Patras, Greece
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Stirma GA, Secundino AR, Baracho FR, Dau L. Bilateral Erecta Luxation: A Case Report and Literature Review. JBJS Case Connect 2021; 10:e1900231. [PMID: 32960009 DOI: 10.2106/jbjs.cc.19.00231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 69-year-old man fell from a height, resulting in direct axial loading while both shoulders were fully abducted. He was referred to the surgical ward, and both shoulders were reduced by closed reduction using the traction-countertraction maneuver. After little improvement of complaints of pain in the right shoulder over 45 days, magnetic resonance demonstrated traumatic rupture of the supraspinatus. CONCLUSION Inferior dislocation (luxation erecta) is an uncommon event, with bilateral dislocation being even rarer. Treatment should be initiated urgently via closed reduction or, if this is not possible, through open reduction. The long-term prognosis is favorable after appropriate treatment.
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Affiliation(s)
- Guilherme Augusto Stirma
- 1Department of Orthopedic Surgery, Shoulder and Elbow, Federal University of Paraná-UFPR, Curitiba, Brazil
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Kouzelis A, Kokkalis ZT, Lachanas I, Matzaroglou C, Solomou A, Panagopoulos A. Arthroscopic Treatment of Luxatio Erecta Humeri Associated with Greater Tuberosity Fracture, Bankart Lesion, and Partial Rotator Cuff Tear: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923727. [PMID: 32555129 PMCID: PMC7322212 DOI: 10.12659/ajcr.923727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/13/2020] [Accepted: 04/11/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Luxatio erecta humeri (LEH) is a rare injury present in only 0.5% of shoulder dislocations. Much of the relevant literature is focused on the initial management and proper reduction techniques, although the prevalence of associated injuries can reach 80%. A case of LEH associated with greater tuberosity (GT) fracture and rotator cuff (RC) tear in a young laborer managed with closed reduction and arthroscopic repair of the labrum and rotator cuff is presented. CASE REPORT A 28-year-old man presented to our hospital with severe pain in his right shoulder after a high-impact motor vehicle accident. Standard anteroposterior radiographs revealed an inferior dislocation (LEH) of the right shoulder and a fracture of the GT. The patient was initially managed with closed reduction under mild intravenous sedation, using a 2-step maneuver followed by arthroscopic evaluation of the joint the next day. During arthroscopic evaluation, an anterior-inferior Bankart lesion, impaction of the humeral head with a minimal displaced GT fracture, and a partial RC tear were identified and successfully treated arthroscopically. The patient had immobilization in a simple sling for 6 weeks and he followed a standard 3-month physiotherapy protocol for rotator cuff, finally regaining almost normal range of shoulder motion at 1 year. CONCLUSIONS Although very good results of non-operative treatment of LEH have been reported in the literature, the co-existence of intra-articular lesions such as labral and rotator cuff tears makes arthroscopic repair an attractive alternative in individual cases.
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Affiliation(s)
- Antonis Kouzelis
- Department of Orthopaedics, University Hospital, Patras Medical School, Patras, Greece
| | - Zinon T. Kokkalis
- Department of Orthopaedics, University Hospital, Patras Medical School, Patras, Greece
| | - Ioannis Lachanas
- Department of Orthopaedics, General Army Hospital of Athens, Athens, Greece
| | | | | | - Andreas Panagopoulos
- Department of Orthopaedics, University Hospital, Patras Medical School, Patras, Greece
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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.
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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
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Gökkuş K, Sagtas E, Saylik M, Aydın AT, Atmaca H. Luxatio erecta humeri: Report of a swimming injury with analysis of the mechanism of the injury and associated injuries in literature. J Emerg Trauma Shock 2015; 8:43-8. [PMID: 25709253 PMCID: PMC4335157 DOI: 10.4103/0974-2700.150397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 11/02/2014] [Indexed: 11/04/2022] Open
Abstract
Inferior shoulder dislocation also referred to as luxatio erecta is an unusual and rare type of shoulder dislocation. Its incidence is about 0.5% among all shoulder dislocations. After an exhaustive search of all the available literature we were unable to find a swimming accident case that did not have other associated injuries and an uneventful reduction. The mechanism of the injury was mostly related to direct axial loading and indirect hyperabduction lever arm. We would like to emphasize the importance of this being a swimming accident, a type of accident that requires awareness of the possibility of dangerous asphyxia injuries caused by panic in the water (swimming pool, river, lake, sea, etc.). We described the nature of the injury and review the literature concerning the mechanism of the injury and associated neurovascular impairment at admission time. We also presented a supplemental video to contribute to the education of young residents and orthopedic surgeons.
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Affiliation(s)
- Kemal Gökkuş
- Department of Orthopaedics and Trauma, Antalya Memorial Hospital, Antalya, Turkey
| | - Ergin Sagtas
- Department of Radiodiagnostic, Antalya Memorial Hospital, Antalya, Turkey
| | - Murat Saylik
- Department of Orthopaedics and Trauma, Ozel Bahar Hospital, Bursa, Turkey
| | - Ahmet Turan Aydın
- Department of Orthopaedics and Trauma, Antalya Memorial Hospital, Antalya, Turkey
| | - Halil Atmaca
- Department of Orthopaedics and Trauma, Akdeniz University School of Medicine, Merkez, Antalya, Turkey
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Madani T, Hani R, Karabila MA, Kharmaz M, El Ouadghiri M, Lahlou A, Lamrani MO, El Bardouni A, Mahfoud M, Berrada MS, El Yaacoubi M. [Bilateral dislocation erecta: report of a case]. Pan Afr Med J 2015; 22:316. [PMID: 26977225 PMCID: PMC4769812 DOI: 10.11604/pamj.2015.22.316.7456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 11/12/2015] [Indexed: 11/13/2022] Open
Abstract
La luxation erecta est une lésion rare, elle est encore plus rare quand elle est bilatérale. Nous rapportons un cas de luxation erecta bilatérale chez un sportif victime d'une chute lors d'une séance de gymnastique. Le patient s'est présenté aux urgences avec une attitude d'abduction irréductible des deux épaules, l'examen vasculo-nerveux était normal. La radiographie a confirmé le diagnostic d'une luxation erecta bilatérale associée à une fracture des deux tubercules majeurs. Le patient a bénéficié d'une réduction orthopédique et d'un bandage coude au corps. Le suivi a montré un score de l'UCLA à 30 points. L'objectif de notre travail est d'insister sur la rareté de la luxation erecta bilatérale et de rappeler sa particularité clinique, thérapeutique et évolutive.
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Affiliation(s)
- Tarik Madani
- Service de Traumatologie-Orthopédie au CHU IBN-Sina, Rabat, Maroc
| | - Redouane Hani
- Service de Traumatologie-Orthopédie au CHU IBN-Sina, Rabat, Maroc
| | | | - Mohammed Kharmaz
- Service de Traumatologie-Orthopédie au CHU IBN-Sina, Rabat, Maroc
| | | | - Abdou Lahlou
- Service de Traumatologie-Orthopédie au CHU IBN-Sina, Rabat, Maroc
| | - Mly Omar Lamrani
- Service de Traumatologie-Orthopédie au CHU IBN-Sina, Rabat, Maroc
| | | | - Mustapha Mahfoud
- Service de Traumatologie-Orthopédie au CHU IBN-Sina, Rabat, Maroc
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Elouakili I, Ouakrim R, Ouchrif Y, Kharmaz M, Ismael F, Lamrani MO, El Bardouni A, Mahfoud M, Berrada MS, El Yaacoubi M. [Dislocation erecta]. Pan Afr Med J 2014; 18:70. [PMID: 25400837 PMCID: PMC4230228 DOI: 10.11604/pamj.2014.18.70.4538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 05/19/2014] [Indexed: 11/11/2022] Open
Abstract
La luxation de l'épaule dans sa forme erecta est une variété rare elle représente 0.5% de toute les luxations de l'épaules. Peu de cas ont été signalés, et le résultat du traitement a été mal défini. Entre 2001 et 2010, 09 patients avec luxation erecta ont été évalue dans notre formation. Il s'agit de huit hommes et une femme d’âge moyen de 31,5 ans. L'épaule droite était luxée dans sept cas, et le mécanisme était direct chez deux patients. L'attitude de l'épaule a été typique dans tous les cas avec un membre supérieur en abduction forcée, bras en l'air et impossibilité de ramener le coude au corps. Aucun trouble vasculaire n'a été noté par contre une atteinte nerveuse a été retrouvé dans 5 cas avec une évolution simple. La radiographie de l'épaule de face a objectivé une luxation inférieure de la tête humérale et un axe diaphysaire au-dessus de l'horizontale dans toutes nos observations. Le traitement a consisté en une réduction sous anesthésie générale suivie d'un bandage type Dujarier pendant trois semaines. La luxation de l'épaule type erecta constitue la forme type de la luxation inférieure, son mécanisme est une chute sur le membre supérieur en grande abduction ou antépulsion. Le diagnostic clinique est facile, confirmé par la radiographie de l'épaule de face. Le pronostic fonctionnel à long terme est excellent.
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Affiliation(s)
- Issam Elouakili
- Service de Traumatologie-Orthopédie, CHU Ibn Sina, Rabat, Maroc
| | | | - Younes Ouchrif
- Service de Traumatologie-Orthopédie, CHU Ibn Sina, Rabat, Maroc
| | | | - Farid Ismael
- Service de Traumatologie-Orthopédie, CHU Ibn Sina, Rabat, Maroc
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Surgical repair and rehabilitation of a combined 330° capsulolabral lesion and partial-thickness rotator cuff tear in a professional quarterback: a case report. J Orthop Sports Phys Ther 2013; 43:142-53. [PMID: 23404091 DOI: 10.2519/jospt.2013.3726] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Case report. BACKGROUND Traumatic glenohumeral dislocations with concomitant rotator cuff and capsular injuries present a unique and challenging surgical and rehabilitative condition, particularly in the overhead-throwing athlete. Multiple injuries of the shoulder complex create the potential for complications in the course of recovery and place a full return to high-level sport at risk. The purpose of this case report is to present the multiphased rehabilitation approach of an elite professional quarterback after an acute 330° capsulolabral reconstruction and rotator cuff repair as a result of a luxatio erecta injury. CASE DESCRIPTION A 26-year-old male professional football player, a quarterback, sustained a right luxatio erecta shoulder dislocation while trying to recover a fumble during a regular-season game. The injury occurred when he was hit in the back of his throwing shoulder, which was in an abducted and externally rotated position, while lying on the ground. Five days postinjury, he underwent a 330° capsulolabral repair, with concomitant rotator cuff repair and subacromial decompression. He completed 28 weeks of a multiphased rehabilitation program. OUTCOMES The patient returned to play in the National Football League (NFL) 8 months later, for the start of the next season, during which he had his most productive year as a professional quarterback, leading the league in passing yards and finishing third in the league for the number of touchdowns. Since the injury, the patient has played 6 consecutive seasons, starting over 96 consecutive, regular-season games and maintaining a very high level of play. DISCUSSION This case report highlights the clinical decision-making process and management of this rare, severe injury.
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Acosta CAX, da Silva Resch E, Rodrigues R. BILATERAL LUXATIO ERECTA, A CASE REPORT. Rev Bras Ortop 2012; 47:130-2. [PMID: 27047840 PMCID: PMC4799377 DOI: 10.1016/s2255-4971(15)30357-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Accepted: 12/01/2011] [Indexed: 11/25/2022] Open
Abstract
Inferior shoulder dislocation (luxactio erecta) is a rare lesion affecting approximately 0.5% of dislocations of this joint. The vast majority of these cases occur unilaterally. In September 2004, a 43 year old man was brought to the emergency room of the University Hospital of Santa Maria (HUSM) complaining of bilateral shoulder pain and inability to lower the arms, as a result of a fall with the arms abducted, while carrying out work activities. After physical examination and radiological exams, it was found that the patient had a bilateral inferior shoulder dislocation. He was referred to the surgical ward and after intravenous sedation, both shoulders were reduced by closed reduction using the traction-countertraction maneuver. The patient was discharged the day after the reduction. Both arms were immobilized with a velpeau sling in total adduction and intrarotation, with instructions to maintain immobilization for three weeks. The patient was also advised to receive physiotherapy.
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Affiliation(s)
- César Augusto Xavier Acosta
- Orthopedic and traumatology physician of the Orthopedics and Traumatology Service of the Hospital Universitário de Santa Maria - RS, Brasil
| | | | - Rafael Rodrigues
- Specialist resident physician in orthopedics and traumatology at the Hospital Universitàrio de Santa Maria - RS, Brasil
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11
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Groh GI, Wirth MA, Rockwood CA. Results of treatment of luxatio erecta (inferior shoulder dislocation). J Shoulder Elbow Surg 2010; 19:423-6. [PMID: 19836975 DOI: 10.1016/j.jse.2009.07.062] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 07/07/2009] [Accepted: 07/12/2009] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Traumatic inferior shoulder dislocation (luxatio erecta) injuries are rare, comprising less than 0.5% of all shoulder dislocations. Few cases have been reported, and the outcome of treatment has been ill defined. MATERIALS AND METHODS Between 1968 and 2000, 18 patients (20 shoulders) with luxatio erecta were evaluated at our institution. Two patients (2 shoulders) were lost to follow-up, leaving 16 patients (18 shoulders) for long-term follow-up (average, 9 years). Associated injuries included peripheral nerve injury, humeral fracture, acromial fracture, and rotator cuff tear. All patients were initially managed with closed reduction, which was successful in 9 shoulders. The remaining 9 shoulders required operative treatment. RESULTS Patients were evaluated with respected to pain, function, range of motion, strength, and patient satisfaction, according to the University of California at Los Angeles Rating Scale. Overall, 13 of the 16 patients were graded as good or excellent. Patients treated with closed reduction or operative treatment compared favorably in terms of improvements in ratings for pain, strength, motion, and the ability to perform work and sports. DISCUSSION Our experience suggests that treatment of luxatio erecta is largely successful, with good or excellent results obtained in 83% of the shoulders. Half of the patients evaluated, required only closed reduction as their definitive treatment. Operative treatment is typically indicated for associated displaced humeral head fractures or patients with recurrent instability. Recurrent instability appears to be more likely in patients with a previous history of dislocation. Associated neurologic or vascular injury did not affect the final outcome.
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Affiliation(s)
- Gordon I Groh
- Blue Ridge Bone and Joint Clinic, Asheville, NC 28801, USA.
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12
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Mitchell MJ, Gray AC, Robinson CM. Inferior shoulder instability due to an engaging superior Hill-Sachs lesion: a case report. J Shoulder Elbow Surg 2007; 17:e1-3. [PMID: 17931897 DOI: 10.1016/j.jse.2007.02.121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Accepted: 02/21/2007] [Indexed: 02/01/2023]
Affiliation(s)
- Martin J Mitchell
- Shoulder Injury Clinic, New Royal Infirmary of Edinburgh, Edinburgh, Scotland.
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13
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Tomcovcík L, Kitka M, Molcányi T. Luxatio Erecta Associated with a Surgical Neck Fracture of the Humerus. ACTA ACUST UNITED AC 2004; 57:645-7. [PMID: 15454818 DOI: 10.1097/01.ta.0000038552.72461.e7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- L'ubos Tomcovcík
- Clinical Department of Trauma Surgery, Faculty Hospital of Louis Pasteur, Kosice, Slovak Republic.
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