Current Issue Search Articles Instructions for authors
 

 HOME | Login   

 

 Small font sizeDefault font sizeIncrease font size Print this article Email this article Bookmark this page
 Users online: 84


  In this article
    Abstract
    Introduction
    Case Report
    Operative Technique
    Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed3461    
    Printed162    
    Emailed1    
    PDF Downloaded106    
    Comments [Add]    
    Cited by others 1    

Recommend this journal

 
 
Year : 2008  |  Volume : 2  |  Issue : 4  |  Page : 83-84    Table of Contents


 
CASE REPORT

Dynamic posterior stabilization of shoulder hemiarthroplasty in long-standing neglected posterior dislocation of the glenohumeral joint

Orthopedic Specialist Registrar, Wrexham Maelor Hospital, Croesnewydd Road, Wrexham, LL13 7TD, United Kingdom

Correspondence Address:
Jeremy Oakley
6 Kingfisher Way, Morda, Oswestry- SY109LX
United Kingdom
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-6042.44145

Rights and Permissions

 

 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Article in PDF (43 KB)
Reader Comments
Access Statistics
Citation Manager
Add to My List *
* Registration required (free)

   Abstract 

Posterior dislocations of the shoulder are rare. They account for less than 3% of all shoulder dislocations. The treatment of neglected bilateral posterior dislocation of the shoulder is controversial. We present a novel operative technique to stabilize a shoulder hemiarthroplasty that we used in the treatment of a chronic posterior dislocation of a shoulder with an acute four-part fracture of the proximal humerus.


Keywords: Chronic, hemiarthroplasty, posterior shoulder dislocation


How to cite this article:
Shyam Kumar A J, Oakley J, Wootton J. Dynamic posterior stabilization of shoulder hemiarthroplasty in long-standing neglected posterior dislocation of the glenohumeral joint. Int J Shoulder Surg 2008;2:83-4

How to cite this URL:
Shyam Kumar A J, Oakley J, Wootton J. Dynamic posterior stabilization of shoulder hemiarthroplasty in long-standing neglected posterior dislocation of the glenohumeral joint. Int J Shoulder Surg [serial online] 2008 [cited 2019 Jun 19];2:83-4. Available from: http://www.internationalshoulderjournal.org/text.asp?2008/2/4/83/44145



   Introduction Top


Posterior dislocations of the shoulder are rare. They account for less than 3% of all shoulder dislocations. [1],[2],[3] The treatment of neglected bilateral posterior dislocation of the shoulder is controversial. Proposed treatment methods include shoulder hemiarthroplasty or acute osteochondral autografting. [4],[5]


   Case Report Top


A 60-year-old male with mild learning difficulties presented to the clinic with increasing pain and difficulty in moving both shoulders for approximately 1 week. He denied any history of trauma. The patient was a known epileptic suffering from recurrent fits. Clinical examination revealed significant wasting of the deltoid bilaterally, with minimal bruising around both shoulders. There was limitation of movement of both shoulders in all directions due to pain. Distal neurovascularity was normal. Radiographs revealed chronically neglected bilateral posterior shoulder dislocations with an acute four-part fracture of the proximal humerus on the right side [Figure 1]. The patient and his family consented for surgery after a lengthy discussion. The right side was treated with a hemiarthroplasty with posterior stabilization using the long head of the biceps tendon (see technique below). Six weeks later, the left side was treated with open reduction and McLoughlin procedure.


   Operative Technique Top


In the beach-chair position access to the proximal humerus was obtained through the deltopectoral approach. The humeral head was found to be highly comminuted. The posterior capsule was virtually nonexistent, with the presence of a large cavity posterior to the glenoid indicating the chronicity of the posterior dislocation of the humeral head. The rotator cuff, along with its insertion into the greater tuberosity, was intact although moderately degenerate. A hemiarthroplasty was performed using the Equinoxe fracture stem (Exatech Ltd.) with the prosthesis inserted in 5 of retroversion. The greater and lesser tuberosities were reattached to the fracture stem using 5-0 ethibond sutures (Ethicon Ltd.). Despite the adequate retroversion, the prosthesis was grossly unstable posteriorly due to the nonexistent posterior capsule. The long head of the biceps was tenotomized close to its origin on the supraglenoid tubercle and was rerouted posteriorly. It was attached to the middle of the posterior rim of the glenoid using DePuy Mitek TM suture anchors (Johnson and Johnson Ltd.), thus creating a dynamic posterior restraint and preventing posterior dislocation of the prosthesis [Figure 2] and [Figure 3]. Postoperatively, the arm was rested in a polysling in internal rotation, with the forearm resting on the abdomen, for 2 weeks. Passive range of motion exercises were commenced at 2 weeks post-op, progressing to active assisted mobilization after a further 2 weeks. At 6 months' follow-up the patient was pain free and the shoulder remained stable despite a further episode of convulsions. His active forward elevation and abduction were 70 and 60, respectively. Active external rotation was 20 and internal rotation allowed his hand to reach his upper lumbar spine. Functionally, he was able to reach his mouth for feeding himself and could brush his hair.


   Discussion Top


As far as we are aware, this technique for posterior shoulder stabilization has not been previously reported in such a clinical situation. A similar technique has been described by Boyd and Sisk for recurrent posterior dislocation of the native joint but not for arthroplasty of the shoulder. [6] Posterior capsulorrhaphy has also been described for a posteriorly unstable shoulder arthroplasty. [7] This technique, however, cannot be used in situations where the posterior capsule is nonexistent due to the chronicity of the dislocation.

 
   References Top

1.Dorgan JA. Posterior dislocation of the shoulder. Am J Surg 1955;89:890-900.  Back to cited text no. 1  [PUBMED]  
2.Hawkins RJ, Neer CS 2nd, Pianta RM, Mendoza FX. Locked posterior dislocation of the shoulder. J Bone Joint Surg Am 1987;69:9-18.  Back to cited text no. 2  [PUBMED]  
3.Cicak N. Posterior dislocation of the shoulder. J Bone Joint Surg Br 2004;86:324-32.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Connor PM, Boatright JR, D'Alessandro DF. Posterior fracture dislocation of the shoulder: Treatment with acute osteochondral grafting. J Shoulder Elbow Surg 1997;6:480-5.  Back to cited text no. 4  [PUBMED]  
5.Ivkovic A, Boric I, Cicak N. One-stage operation for locked bilateral posterior dislocation of the shoulder. J Bone Joint Surg Br 2007;89:825-8.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Boyd HB, Sisk TD. Recurrent posterior dislocation of the shoulder. J Bone Joint Surg Am 1972;54:779-86.  Back to cited text no. 6  [PUBMED]  
7.Kontakis GM, Tozakidou M, Karantinos J. Stabilisation of a posteriorly unstable glenohumeral joint during total shoulder arthroplasty: A Novel capsulorraphy technique. Acta Orthop Belg 2006;72:353-5.  Back to cited text no. 7  [PUBMED]  


    Figures

  [Figure 1], [Figure 2], [Figure 3]


This article has been cited by
1 Open management of neglected inferior dislocation of the shoulder with proximal humeral fracture in an adolescent
Shabir Ahmed Dhar,Sharief Ahmed Wani,Tahir Ahmed Dar,Shahid Hussain,Reyaz Ahmed Dar,Abdul Rouf Malik
Strategies in Trauma and Limb Reconstruction. 2013; 8(1): 53
[Pubmed] | [DOI]



 

Top
Print this article  Email this article