Iatrogenic fracture during shoulder dislocation reduction: characteristics, management and outcomes

Tang's method is an effective new treatment for anterior shoulder dislocation

The principal aim of this study was to present a novel approach to manipulative repositioning for the management of anterior shoulder dislocation. This was evaluated in comparison with the established repositioning method to ascertain its clinical efficacy. Seventy-six patients with anterior dislocation of the shoulder joint were randomly assigned to one of two groups. Each group underwent reducing using either Tang's method or Hippocrates' method, respectively. The patients were then monitored for six months. The researchers analyzed and compared the general condition, reduction time, reduction success rate, VAS score, and ASES score of the patients in the two groups. No statistically significant difference was observed in the general condition of the patients prior to the reduction between the two groups. The mean reduction time for the Tang's method group (70.9 ± 11.88) was found to be significantly shorter than that observed for the Hippocrates method group (411.6 ± 50.41). The reduction success rate was significantly higher in the Tang's method group (100.00%) than in the Hippocrates method group (80.56%). No statistically significant difference was observed in VAS scores between the two groups prior to the reduction. However, the Tang's method group demonstrated superior outcomes compared to the Hippocrates method group during and following the reduction. No statistically significant difference was observed in ASES scores between the two groups prior to the reduction. However, at one, three, and six months post-reduction, the Tang's method group exhibited significantly superior outcomes compared to the Hippocrates method group. The Tang's method is a safe and effective method of reducing for anterior dislocation of the shoulder. It is significantly superior to the traditional Hippocrates method.

A Locked Posterior Shoulder Dislocation: An Injury Not to Miss

Locked posterior shoulder dislocations are dislocations that remain unreduced for more than three weeks. In most cases, they are associated with other injuries. We report the case of a 38-year-old male who presented with pain and total functional impotence due to a complex injury, including posterior glenohumeral dislocation, a reverse Hill-Sachs lesion, and a clavicle fracture. Because of the unsuccessful attempts at closed reduction, the patient underwent surgery. We performed the McLaughlin technique, which included the transfer of the subscapularis tendon to the reverse Hill-Sachs lesion, stabilized by bone anchors. At the last follow-up, the patient was doing well and had regained full range of motion with no recurrent dislocation. Clinicians should maintain clinical and radiological suspicion about this injury to timely manage this rare and dangerous injury.

Management of greater tuberosity fracture dislocations of the shoulder

Background

Despite extensive literature dedicated to determining the optimal treatment of isolated greater tuberosity (GT) fractures, there have been few studies to guide the management of GT fracture dislocations. The purpose of this review was to highlight the relevant literature pertaining to all aspects of GT fracture dislocation evaluation and treatment.

Methods

A narrative review of the literature was performed.

Results

During glenohumeral reduction, an iatrogenic humeral neck fracture may occur due to the presence of an occult neck fracture or forceful reduction attempts with inadequate muscle relaxation. Minimally displaced GT fragments after shoulder reduction can be successfully treated nonoperatively, but close follow-up is needed to monitor for secondary displacement of the fracture. Surgery is indicated for fractures with >5 mm displacement to minimize the risk of subacromial impingement and altered rotator cuff biomechanics. Multiple surgical techniques have been described and include both open and arthroscopic approaches. Strategies for repair include the use of transosseous sutures, suture anchors, tension bands, screws, and plates. Good-to-excellent radiographic and clinical outcomes can be achieved with appropriate treatment.

Conclusions

GT fracture dislocations of the proximal humerus represent a separate entity from their isolated fracture counterparts in their evaluation and treatment. The decision to employ a certain strategy should depend on fracture morphology and comminution, bone quality, and displacement.

F, Meisterhans M, Borbas P, Wieser K, Grubhofer F. Anterior shoulder dislocation with avulsion fracture of the greater tuberosity results in reliable good outcomes after closed reduction

Background

Avulsion of the greater tuberosity (GT) due to traumatic anterior shoulder dislocation (ASD) is a commonly observed fracture pattern. After closed reduction of the dislocated humerus, the GT typically reduces itself into its anatomic position enabling the patient to undergo conservative treatment. The aim of this study was to retrospectively review a consecutive series of patients with conservatively treated GT avulsion fractures after closed reduction of an ASD and analyze radiographic outcome, shoulder function and glenohumeral stability and the conversion rate to surgical treatment.

Methods

All patients who underwent closed reduction of a GT avulsion fracture after ASD with the primary intention of conservative treatment between 2017 and 2022 were included. Complications (i.e. conversion to surgical treatment), shoulder function assessed with the American Shoulder and Elbow Surgeons score and subjective shoulder value, instability assessed with the Western Ontario Shoulder Instability score, radiological impingement (greater tuberosity index = GTI and impingement index = II) and GT fracture pattern were assessed as outcome measurements.

Results

A total of 29 patients (mean age 44 years, 27% female) with a mean follow-up of 32.6 (range, 8-96) months were enrolled. Seven patients (24%) underwent surgery due to secondary displacement (n = 4, 14%) or impingement symptoms (n = 3, 10%). All patients who underwent secondary surgery showed a multifragmentary fracture pattern of the GT. Shoulder stiffness (n = 7) and neuropraxia of the axillary nerve (n = 3) were observed temporarily and resolved during the follow-up period. The American Shoulder and Elbow Surgeons and subjective shoulder value of the conservatively treated patients at the last follow-up was 89.2 ± 19.1 respectively 86 ± 18.2%. No recurrent glenohumeral dislocation was documented. The mean Western Ontario Shoulder Instability score at last follow-up was 8(0-71). The mean GTI decreased from 1.2 ± 0.1 after ASD to 1.1 ± 0.1 at the last follow-up (P = .002). The mean II decreased from 0.6 ± 0.5 after ASD to 0.4 ± 0.3 at the last follow-up (P = .110).

Conclusion

The GT avulsion fragment reduces typically into a close to anatomic position after closed reduction and the GTI even improves with further conservative treatment over time. Close radiological follow-up is necessary to rule out secondary displacement which occurs typically in a multifragmentary fracture pattern. Patients without the need for surgery showed good clinical outcomes without recurrence of glenohumeral instability.

Modified chair method: an easy and efficient reduction method without medication for anterior shoulder dislocation

BACKGROUND

Various maneuvers have been introduced to address anterior shoulder dislocations. Chair method allows the patient to sit comfortably and feel less pain during the reduction procedure. However, the rarity of comparative studies led to a lack of evidence to popularize. The present study aimed to introduce a modified chair (MOC) reduction method for anterior shoulder dislocation and explore its effectiveness compared with the traditional Hippocratic approach.

METHODS

This is a single-center retrospective study of 257 patients with anterior shoulder dislocation from September 2020 and July 2021. Patients were divided into two groups according to the reduction method they received (either the Hippocratic method or the MOC method). Success rate, reduction time, visual analog scale (VAS) pain score, satisfaction level, and a new indicator, pain index (reduction time (s)* VAS/ 10), were compared.

RESULTS

One hundred sixteen patients (43 females, 73 males) underwent the Hippocratic method, and 141 (65 females, 76 males) MOC method. A significantly higher success rate was seen in the MOC group (96.5%(136/141) vs. 84.5%(98/116) in the Hippocratic group; OR 5, 95%CI 1.79 ~ 13.91; p = 0.002). Pain index of the patients in the MOC group was much lower than that in the Hippocratic group (3.20 (2.10, 4.53) vs. 36.70 (22.40, 47.25), p <  0.001). The reduction time, VAS pain score, and satisfaction level also favored the MOC method.

CONCLUSIONS

The MOC method is an easy and efficient reduction method with minimum assistance for anterior shoulder dislocations. Physicians can skillfully perform this procedure with the help of their body weight. The MOC method could be attempted for shoulder dislocations in the emergency department.

Han's technique: a new reduction technique for acute anterior shoulder dislocation

INTRODUCTION

Acute anterior shoulder dislocation (AASD) is the most common joint dislocation. Here, we introduced a new reduction technique for AASD, named "Han's technique" (or "Touch overhead technique").

METHODS

Patients diagnosed with AASD were treated with "Han's technique" in the orthopaedic department of our hospital from October 2018 to November 2020. An orthopedic surgeon performed the reduction maneuver without any anesthesia or sedation throughout the reduction process. The fundamental information and related data were recorded, including patients' age, sex, dislocation side, previous dislocations history, reduction time, number of attempts at reduction, success rate of the reduction, intensity of pain during reduction using the 10-point visual analogue scale score (VAS), any complications, with or without the fracture and neurovascular examination results.

RESULTS

Forty-one patients with AASD were involved in our study. Thirty-nine cases (95%) were primary dislocation. Eleven patients (27%) were complicated with large tubercle fracture and one patient (2%) complicated with inferior glenoid fractures. All patients were successfully reduced by Han's technique with mean reduction time was 138 s. The pain score during the reduction operation is only1.83 ± 0.83 points. No neurovascular injury or iatrogenic fracture was found after reduction in all patients.

CONCLUSIONS

Han's technique (or Touch overhead technique) is a simple, safe, effective, mild and easy to master which can be operated by one surgeon without anesthesia or sedation for AASD.

Arthroscopic Reduction of a Missed/Neglected Anterior Shoulder Dislocation and Concomitant Repair of the Rotator Cuff Tendon

Patients with neglected/missed anterior shoulder dislocation and an associated rotator cuff tear present a dilemma for the correct surgical approach that will facilitate a reduction of the dislocation and repair of the rotator cuff tear. This report describes an arthroscopic technique using standard arthroscopic portals to reduce neglected (3-6 weeks) anterior shoulder dislocation and repair the rotator cuff tendon. The arthroscopy is performed in a beach chair position using anterolateral and anteromedial portals for reduction of the shoulder dislocation. The same anterolateral portal is used as a viewing portal, and the anteromedial portal and an additional lateral portal are used for subsequent rotator cuff repair.

Glenohumeral joint dislocation is rare in children with proximal humeral fractures: a descriptive study and literature review

Background

Glenohumeral dislocation combined with fracture of the proximal humerus is extremely rare in children, and this study aims to investigate its incidence in the pediatric population and review the treatment strategy for this condition.

Methods

Between Jan 2014 and Jan 2019, 280 patients with unilateral proximal humeral fractures were retrospectively reviewed. Imaging and follow-up notes were reviewed for patients with a predilection for glenohumeral joint dislocation. Six (2.14%) patients between the ages of 5 and 10 years were confirmed as glenohumeral joint dislocation and included in the study. All these patients underwent closed reduction and external fixation under general anesthesia.

Results

Out of 280 patients with proximal humeral fractures, only 6 patients, including 4 males and 2 females, were confirmed as glenohumeral joint dislocation. ROM was normal compared with the contralateral shoulder in every patient at the last follow-up. There was no case of radiological abnormality, including avascular necrosis or devascularization of the humeral head.

Conclusions

Glenohumeral dislocation is a rare entity associated with the proximal humerus fracture in children, with an overall incidence in our case series was 2.14%.

Reduction and stabilization of such injury using an external fixator is a suitable choice for pediatric patients that failed closed reduction.