Arthroscopic Bankart Repair vs. Latarjet Procedure for Recurrent Shoulder Instability: A Meta-Analysis of Clinical Outcomes and Complication Rates in General and Athletic Populations.

BACKGROUND: The Bankart repair and Latarjet procedure are both effective surgical methods for treating repeated recurrent anterior dislocation of the shoulder. However, there is still little consensus regarding the standard treatment for recurrent anterior instability of the shoulder. Typically, the choice of treatment has been influenced more by training and tradition rather than the existing evidence. This systematic review and meta-analysis aimed to compare patient-reported outcomes, recurrence, and complications between the two procedures, among both athletic and non-athletic cohorts. METHODS: Relevant clinical trials were identified through a systematic search of databases in April 2023 including PubMed, Scopus, Web of Science, and Cochrane. RCTs and cohort studies were included if they compared patient-reported outcomes or complication rates of open Latarjet procedure versus arthroscopic Bankart repair. Continuous data, such as patient-reported outcomes were pooled as the weighted mean difference (WMD). For dichotomous data such as recurrence and revision rates, the pooled risk ratio (RR) with 95% confidence intervals (CIs) was calculated using random effects meta-analysis. RESULTS: 21 clinical studies (3 RCTs) were included in the meta-analysis involving a total of 13176 operated shoulders. Arthroscopic Bankart showed a 3.08 times higher risk of recurrence and revision due to post operation instability (RR=3.08, 95% CI: 2.03 to 4.68) compared to those who had the Latarjet approach. The ROWE score, was higher in the Latarjet group by an average of 4.55 points (95% CI: 2.41 to 6.68). This difference was more pronounced in athletes, with an increase of 5.47 points (95% CI: 0.16 to 10.78), compared to the non-athletic population: 4.03 (95% CI: 2.04 to 6.02). Return to sport time was shorter by 0.40 months (95% CI: -0.75 to -0.05) in the Latarjet group. The total complication rate was approximately 47% lower in the Bankart group (RR=0.53, 95% CI: 0.31-0.90). Additionally, the risk of hematoma was 75% lower in patients undergoing the arthroscopic Bankart compared to the Latarjet procedure. External rotation, assessed both in abduction and adduction of the arm, as well as forward elevation, show no significant differences between the two groups. CONCLUSION: Our results demonstrate that the Latarjet procedure has a lower recurrence rate, excels in patient-reported outcomes, and requires less time for return to sports. Thus, it may be a superior alternative to arthroscopic Bankart repair. However, it is still associated with a higher incidence of complications.

Neglected Anterior Dislocation of Hip Managed with Total Hip Arthroplasty Using Dual Approach: A Case Report and Review of Literature.

Introduction: Traumatic hip dislocations frequently result from road traffic accidents and are prevalent in developing nations. Untreated dislocations either due to ignorance or lack of proper treatment become more challenging to manage and have an increased likelihood of developing avascular necrosis (AVN). Over time, closed methods of reduction become impractical, and if the waiting period surpasses 3 months, open reduction likewise becomes unworkable. Anterior dislocations are less common than posterior dislocations, accounting for a frequency of 7-13% of all hip dislocations. Neglected anterior hip dislocations are extremely rare, and therefore, there is a paucity of information about the management of these dislocations and associated injuries. The available treatment options for these particular situations are total hip arthroplasty (THA), Girdlestone surgery, or hip arthrodesis. Case Report: We describe the case of a 49-year-old male who presented to our hospital with a neglected anterior dislocation of the hip. The patient disclosed a history of hip trauma 8 months ago, initially receiving conservative management. However, due to persistent pain and functional limitations, he sought further medical attention. A physical examination, radiographic evaluation, and computed tomography (CT) scan confirmed the diagnosis. The patient underwent THA using dual anterior and posterior approaches, followed by a comprehensive rehabilitation program. Conclusion: Anterior dislocation of the hip is a relatively rare condition, and its neglected presentation is even rarer. This case highlights the importance of prompt diagnosis and early intervention in neglected anterior hip dislocations to minimize complications and optimize patient outcomes.

Anterior shoulder dislocation: A bibliometric analysis in the past two decades (2003-2022).

Background: Anterior shoulder dislocation is the most common type of shoulder dislocation and is easy to develop into recurrent type, causing economic burden to society. This study uses the bibliometric method to analyze the global research status, hotspots and trends of anterior shoulder dislocation, aiming to promote the exploration of anterior shoulder dislocation. Methods: The literature on anterior shoulder dislocation in the past two decades were retrieved and downloaded from the Web of Science Core Collection (WOSCC) database. CiteSpace, VOSviewer and bibliometrix package of R software were used to conduct scientific bibliometric analysis of the literature. Finally, some statistical graphics were performed in Graphpad Prism. Results: A total of 3914 publications related to anterior shoulder dislocation from 2003 to 2022 were retrieved and screened from the WOSCC database. The ranking of the analysis results showed that Provencher MT was the author with the highest frequency of occurrence. Rush University was the most notable contributor. The American Journal of Sports Medicine was the most comprehensive journal. The United States was the most prominent country. Keywords related to surgical treatment were more significant than others. Conclusion: In the past two decades, the research output on anterior shoulder dislocation have been increasing year by year. The focus has gradually shifted to surgical treatment. Surgical treatment may continue to be the research hotspots in this field in the future.

Bilateral combined fracture of the greater tuberosity with anterior internal shoulder dislocation.

INTRODUCTION AND IMPORTANCE: Bilateral combined fractures of the greater tuberosity with anterior internal shoulder dislocation are extremely rare, presenting challenges in treatment due to their uncommon occurrence and lack of standardized management protocols. CASE PRESENTATION: We report the case of a 22-year-old patient who experienced bilateral anterior shoulder dislocations with associated fractures of the greater tuberosities following a seizure-induced fall. Clinical Discussion: The unique aspect of our case is the unusual mechanism of injury. Unlike typical convulsive seizures, which often result in bilateral posterior dislocations, our patient suffered bilateral anterior dislocations and fractures of the greater tuberosities. Therapeutic management of greater tuberosity fractures lacks a standardized approach, but surgical intervention is warranted if displacement exceeds 0.5 cm. Treatment options include open reduction and internal fixation (ORIF), percutaneous screw fixation, arthroscopic procedures with suture anchors for double-row repair, or a combination of arthroscopic techniques and screw fixation. ORIF with plate osteosynthesis may be recommended for comminuted fractures with large fragments. To assess functional outcomes, commonly used scoring systems include the UCLA Shoulder Score, ASES Score, and Constant-Murley Score. CONCLUSION: Bilateral anterior shoulder dislocation associated with combined fractures of the greater tuberosity is an extremely rare occurrence. Given its anatomopathological significance and impact on functional recovery, careful and individualized management of greater tuberosity fractures is crucial, considering its role as a point of insertion for the rotator cuff tendons.

Comparison of the Latarjet Procedure With the Modified Putti-Platt Surgery for Recurrent Anterior Shoulder Dislocation With Respect to Functional Outcome.

Introduction Shoulder dislocation is the most common injury encountered in orthopedic outpatient department. The choice of procedure depends on the expertise of surgeons. The objective of this study was to compare the Latarjet procedure with the modified Putti-Platt surgery for recurrent anterior shoulder dislocation in terms of functional outcomes. Materials and methods A quasi-experimental study evaluated 60 patients with recurrent anterior shoulder instability. Patients were assigned to either Latarjet or modified Putti-Platt surgery. Functional outcomes were assessed at six months using the Constant-Murley shoulder score. Results This study encompassed 60 patients (mean age: 23.93±5.88 years) undergoing shoulder procedures. Functional outcomes exhibited a majority of 55% excellent, 35% good, 6.7% fair, and 3.3% poor outcomes. No significant differences in functional outcomes were found between the procedures. Conclusion Both procedures may be viable options for recurrent shoulder instability. The choice may depend on patient factors and surgeon preference. Further research is needed to refine techniques and identify ideal candidates.

Isolated anterior dislocation of the radial head (case report).

We report the case of an isolated post traumatic radial head dislocation in a 5 year old child. Clinical examination and the X ray results allow the diagnosis which can be unnoticed. The reduction by external maneuvers avoids the surgical treatment which remains the gold standard for chronic dislocation.

Neglected and locked anterior shoulder dislocation: functional outcomes and complications after open reduction and preservation of humeral head.

Background: Neglected and locked anterior shoulder dislocation is a rare problem that presents several treatment challenges. Our study aimed to evaluate the functional outcomes and postoperative complications after open reduction and head preservation surgery in patients with neglected and locked anterior shoulder dislocation. Methods: Ten patients (age 51 ± 22 years) with a follow-up of 27 months ± 7 months (range 24-40 months) were included in the study. The anteriorly dislocated humeral heads were open and reduced after an average neglect of 10 ± 15 months. The neglected dislocation was classified into two types by the severity of the injury. (1) Type 1: There were no associated severe injuries, and the humeral head was reduced in the glenoid cavity without take-down of the subscapularis (type 1a) (n = 5) or via take-down of the upper half of the subscapularis (type 1b) (n = 2). (2) Type 2: There were associated factors such as a greater tuberosity fracture (n = 2) or a grade 3/4 fatty infiltrated supraspinatus and infraspinatus muscles (n = 1). Complete removal of the subscapularis was necessary to reduce the humeral head. Results: The pain scores improved from a baseline value of 8 ± 1 to a final value of 1 ± 1 (P < .001), the absolute Constant score improved from a baseline value of 13 ± 8 to a final value of 69 ± 21 (P < .001), elevation range of motion (ROM) improved from a baseline value of 44° ± 43° to a final value of 123° ± 30° (P < .001), external rotation ROM improved from 0° ± 13° to 49° ± 12° (P < .001), and internal rotation ROM improved from sacroiliac joint ± 2 vertebra level to thoracic T11 ± 3 vertebrae level (P < .0001). The final shoulder subjective value was 77 ± 20 and was excellent in 3 patients, good in 5 patients, fair in 1, and poor in 1 patient. Major complications were observed in 30% (n = 3) of patients: persistent humeral head anterior subluxation in 20% (n = 2) of patients and superior migration of the humeral head in 10% (n = 1) of patients. Conclusion: Open reduction and head preservation in patients with neglected anterior dislocation led to good functional outcomes in 70% (as per Constant score) to 80% (as per shoulder subjective value) of the patients. However, we observed major complications such as persistent anterior subluxation (n = 2) and superior head migration (n = 1), leading to suboptimal functional outcomes in cases with associated factors such as a greater tuberosity fracture or severe fatty infiltrated cuff muscles.

Taping Adjunct to Strengthening and Proprioception in a Hill-Sachs Lesion Patient: A Case Report.

A Hill-Sachs lesion is a bony defect in the head of the humerus due to recurrent dislocation, which results in friction between the humeral head and the glenoid fossa. This recurrent incident of dislocation that occurs in the anterior direction eventually leads to a Bankart lesion (a defect in the glenoid rim). A 21-year-old male, a recreational football player, reported recurrent shoulder dislocation, complaining of pain and difficulty doing certain activities. He had hypermobility of the shoulder joint during joint play assessment. Proprioception is the sense of the position and movement of one's own body. Exercises that improve proprioception can help improve shoulder stability and reduce the risk of shoulder injuries. Proprioception has shown significant positive results in shoulder dislocations. A physiotherapy protocol was designed that included strengthening of shoulder and scapular musculatures, proprioceptive exercises, and plyometric exercises for developing agility. All these exercises were given with taping for the shoulder joint. Taping helps stabilize the shoulder and normalizes muscle function. With the help of physiotherapy, patients can avoid invasive procedures for restoring stability in non-traumatic recurrent shoulder dislocations.

Anterior Dislocation of Elbow with Fracture of Medial Epicondyle: A Rare Injury Case Report.

Introduction: Anterior elbow dislocation is a rare occurrence, mostly produced by direct trauma to elbow in flexion attitude following fall from height. Posterior dislocation is the commoner entity at the elbow joint, thus rarity of this case incites reporting. Case Report: A 53-year-old male presented to our outpatient department with complaints of pain, swelling, and inability to move his right upper limb, following fall from height. On examination, no associated neurovascular deficit was found. Radiological investigations confirmed anterior dislocation of elbow joint with medial epicondyle fracture of the right humerus. Dislocation was reduced under general anesthesia with ulnohumeral K-wire and fracture of the medial epicondyle was stabilized by open reduction and internal fixation with K-wire. Conclusion: Anterior dislocation of elbow is a rare occurrence with frequent association with periarticular fractures and neurovascular injury. Therefore, a careful assessment followed by the early proper reduction and management leads to better functional outcome.

First-time traumatic anterior shoulder dislocation: Approach for the primary health care physician.

Traumatic anterior shoulder dislocation is a very common injury encountered in emergency rooms as well as in the primary health care physician's office. This injury occurs either in the setting of competitive or recreational sports injuries or as a high-energy injury during a fall or a road traffic accident. Common complications such as a recurrent dislocation can be predicted, monitored and prevented. Early appropriate treatment of associated cuff tears or fractures is associated with improved outcomes. There is a plethora of literature on the assessment and management of the primary anterior shoulder dislocation in specialised fields such as sports medicine, orthopaedic surgery and shoulder surgery. These studies are often highly technical, addressed to a particular subset of readers and often deal with one aspect of the management of the injury. This narrative aims to provide the reader with a simplified, evidence-based assessment and management approach for the first-time acute anterior shoulder dislocation. Emphasis is on closed reduction techniques, position and duration of immobilisation, and return to activities of life or sports. Risk factors for recurrence and other indications for primary referral to the orthopaedic surgeon are discussed. Other forms of shoulder instability such as posterior shoulder dislocation, inferior dislocation and multidirectional instability will not be the focus of this narrative.

Treatment of Anterior Dislocation of the Sacroiliac Joint via the Lateral-rectus Approach: Surgical Techniques and Preliminary Outcomes.

OBJECTIVE: Anterior dislocation of the sacroiliac joint (ADSIJ) is caused by strong violence, and because of its low morbidity, there are no standardized diagnostic and therapeutical guidelines at this moment. This study aims to explore the surgical techniques and preliminary outcomes of the lateral-rectus approach (LRA) for treating ADSIJ. METHODS: A retrospective study was conducted of 15 patients with ADSIJ from January 2016 to January 2021. The patients' age ranged from 1.8 years old to 57 years old (37 ± 18 years old). All patients underwent open reduction and internal fixation (ORIF) through the LRA. Eight patients were combined with lumbosacral plexus injury and underwent neurolysis during operation. Patients' fracture type, mechanism of injury, associated injuries, operation time and intraoperative bleeding volume were accessed by reviewing medical history. Quality of fracture reduction was evaluated with the Matta score. At 1-year follow-up, the functional rehabilitation was evaluated by the Majeed rehabilitation criteria. For those with lumbosacral plexus injury, the neuromotor function was evaluated using muscle strength grading proposed by the British Medical Research Council (BMRC) and recovery was recorded. RESULTS: All 15 patients underwent the operation successfully. The surgical time ranged from 70 to 220 min (126 ± 42 min), and the intraoperative blood loss ranged from 180 to 2000 mL (816 ± 560 mL). Eighty percent of the cohort (12/15) were rated as excellent and good in the Matta score for fracture reduction quality after operation without surgical incision-related complications. At 1-year follow-up, the overall excellent and good rate was 73.3% (11/15) according to the Majeed criteria, the neuromotor function recovered completely in six cases and partially in two cases according to the BMRC muscle strength grading, and the recovery of sensory function was evaluated as excellent in six cases, good in one case and poor in one case, with an overall excellent and good rate of 87.5%. CONCLUSION: The LRA can well expose the surrounding structures of the sacroiliac joint from the front, which helps surgeons reduce and fix the anterior dislocation of the sacroiliac joint under direct vision and effectively decompress the entrapment of the lumbosacral plexus to achieve better clinical efficacy.

Latissimus Dorsi and Teres major tendon transfer increases internal rotation torque following lateralized reverse shoulder arthroplasty with subscapularis insufficiency.

INTRODUCTION: Limitation of active Internal Rotation (IR) following Reverse Shoulder Arthroplasty (RSA) in patients with massive Rotator Cuff Tears (mRCTs) with subscapularis insufficiency remains a challenge. Recently, RSA with Latissimus dorsi and Teres major (LDTM) transfer in patients with limited active IR has been demonstrated as a reliable treatment option. The purpose of this study was to biomechanically compare the IR torque following LDTM transfer with RSA in mRCT with subscapularis insufficiency to RSA without tendon transfer. METHODS: Eight cadaveric shoulders were tested (mean age: 64.5 ± 1.9 years) using a custom shoulder testing system that permits loading conditions of mRCT with subscapularis insufficiency. Two conditions were tested and compared. The first condition was RSA alone and the second condition was RSA with LDTM transfer. RSA with a medialized glenoid and lateralized humerus design was used for all specimens. The specimens were tested at 0°, 20° and 40° abduction at three different muscle loads: baseline, double, and triple, while the Teres minor and deltoid loads were kept constant. IR torque was measured with a torque wrench at 0°, 20°, and 40° abduction and 60° and 45° IR positions. Force required for anterior dislocation was measured at 20° abduction and 10° IR position. RESULTS: RSA with LDTM transfer had significantly higher IR torque at all abductions and muscle loading compared with RSA without transfer (average at all positions; RSA without transfer: 0.80 ± 0.02 Nm, LDTM transfer for all loads: 1.43 ± 0.10 Nm). RSA with LDTM transfer (91.4 ± 3.9 N) needed higher force for anterior dislocation compared to RSA alone (89.4 ± 4.1 N), but there was no significant difference. CONCLUSION: LDTM transfer with RSA increases IR torque compared to RSA without tendon transfer in a cadaveric model. LDTM transfer with RSA may be a reliable treatment option for patients with mRCT and subscapularis insufficiency who are expected to have limited active IR following RSA.

Neglected Anterior Shoulder Dislocation Treated With Open Reduction and Latarjet Procedure: A Case Report.

According to the literature, cases of neglected anterior shoulder dislocation are extremely rare, which still presents diagnostic and treatment challenges. An extensive surgical procedure is required for their treatment. This situation is still challenging, and there is currently no accepted therapeutic protocol to resolve it. We report the case of a 30-year-old patient who had a right shoulder trauma with an unnoticed antero-medial dislocation. The treatment established was an open reduction combined with the Latarjet procedure followed by good results.

Evaluation of congruency of condyle convexity and fossa concavity and interrelationship bony components in temporomandibular joint anterior dislocation.

OBJECTIVES: This study aimed to compare the congruency of surface geometry of the articulating bones and morphologic differences in temporomandibular joint (TMJ) structure, between patients with TMJ anterior dislocation and healthy controls. METHODS: The study included 15 patients with TMJ anterior dislocation and 15 controls who underwent cone-beam computed tomography. The surface angle of the articular fossa (fossa-concavity) and condyle (condyle-convexity) and joint spaces were measured from both sagittal and coronal views. The articular eminence morphology and horizontal condyle position were also evaluated. RESULTS: Coronal fossa angles were significantly lower in controls than in patients (p < 0.05). There was a positive correlation between coronal condyle and fossa angle values in controls and in patients' joints (p < 0.05), however, the fossa-condylar congruence was higher in controls than in patients. Superior joint space was significantly higher in controls than in patients (p < 0.05). There were no significant differences in articular eminence measurements, mean condyle angle variables and condyle position between the patients and controls (p > 0.05). CONCLUSIONS: The findings of this study which include lower joint congruency, higher fossa concavity and superior joint space distance in patients with anterior dislocation may be related to the inferior positioning of the condyle away from the fossa and potentially the elongation of the capsular ligament.

Anterior Shoulder Dislocation With an Ipsilateral Humeral Shaft Fracture: A Case Report.

Anterior shoulder dislocation is the most common type of shoulder dislocation but if accompanied by an ipsilateral humeral shaft fracture, it becomes extremely rare. There was no clear approach for dealing with these cases. We would like to present a case of a 17-year-old medically free male who was brought to the emergency department by ambulance after a road traffic accident. The patient was conscious, alert, and oriented. His Glasgow Coma Scale (GCS) was 15/15. He had multiple bruises all over his body with obvious swelling in his right arm with an inability to move the arm. There was tenderness over the right arm but an intact distal neurovascular exanimation. X-ray and CT scan showed anterior shoulder dislocation with an ipsilateral humeral shaft fracture of the right arm. There is no specific approach for such cases. However, open reduction with an intramedullary nail showed good outcomes with fewer postoperative neurovascular complications.

[Countertraction method for reduction of irreducible subcoracoid dislocation of the shoulder joint with Hill-Sacks lesion].

OBJECTIVE: To investigate clinical outcomes of countertraction method in treating irreducible subcoracoid dislocation of shoulder joint combined with Hill-Sacks injury. METHODS: A total of 56 patients with irreducible subcoracoid dislocation of the shoulder joint combined with Hill-Sacks injury admitted from December 2013 to June 2020 were retrospectively analyzed. Under the anesthesia of shoulder joint cavity injection, the reduction was performed by using anti-traction method (experimental group) and traditional Hippocrates method (control group), 28 cases in each group. There were 11 males and 17 females in experimental group, with an average age of (61.95±19.32) years old, 9 cases on the left side, and 19 cases on the right side. Twelve males and 16 females in control group, with an average age of (63.13±12.75) years old, 11 cases on the left side, 17 cases on the right side. The curative effects between two groups were evaluated before and after operation, including the success rate of reduction, the duration of reduction, the distance from successful reduction to injury, complications and functional rehabilitation(Constant score of shoulder joint). RESULTS: The success rates of reduction in experimental group and control group were 92.86%(26/28) and 67.86% (19/28), respectively, and the difference was statistically significant (P<0.05). The duration of simple reduction was (4.25±2.13) min and ( 6.31±1.69) min, the difference was statistically significant (P<0.05);the time from successful reduction to injury was (9.16±0.94) h and (8.94±1.31) h, respectively, with no significant difference(P>0.05). There were no complications such as vascular nerve injury and fracture in experimental group, 2 cases of axillary nerve injury and 1 case of humeral head fracture in control group. Constant scores of shoulder joint between experimental group and control group were (92.34±5.62) points and (90.91±4.73) points, respectively, with no significant difference (P>0.05). CONCLUSION: For patients with irreducible subcoracoid dislocation of the shoulder joint with Hill-Sacks injury, the countertraction method under anesthesia of the shoulder joint cavity achieved a higher success rate and few complications.

A Case Report of Closed Reduction of Anterior Transolecranon Fracture Dislocation of Elbow in a Pediatric Patient.

Introduction: Anterior transolecranon fracture dislocation of the elbow is rarely found in pediatric patients, with very few cases reported till now, and very less literature available on its management. Case Report: We hereby present a rare case of trauma to the left elbow in a 9-year-old female child who sustained anterior transolecranon dislocation without neurovascular deficit. Such fracture dislocations are managed usually by surgical methods with or without osteosynthesis. However, we present a report of closed reduction of the condition with good clinical outcomes. Conclusion: Closed reduction can be a safe method of treatment of anterior dislocation of the elbow if no neurovascular deficit is present. This case report aims to highlight this possible treatment method which in itself is unusual for this uncommon pediatric injury.

Anterior dislocation of a total knee arthroplasty in a patient with postoperative delirium: a case report.

We report a rare case of traumatic anterior dislocation in a patient with postoperative delirium following total knee arthroplasty. The patient was successfully treated by open reduction of the dislocation and polyethylene liner change. Recognition of risk factors for postoperative delirium is important for the prevention of this uncommon injury.

Bilateral Proximal Humerus Fracture with Anterior Shoulder Dislocation and Unilateral Chronic Bankart Lesion - A Case Report.

INTRODUCTION: Anterior shoulder dislocation is a common presentation in orthopedic emergency but a bilateral fracture dislocation is a rare entity. Only a few cases have been reported in the literature and their management is still not clear. We present a bilateral four part fracture dislocation with Bankart lesion on right side in a 48 years old. CASE REPORT: A 48-year-old male presented with bilateral proximal humerus fracture with anterior shoulder dislocation following a seizure. He was managed with bilateral PHILOS and Latarjet procedure on right side for a chronic bony Bankart lesion. Superficial infection on left side was managed with debridement. After 1 year period patient had a satisfactory outcome with DASH score of 19.2. CONCLUSION: Bilateral four part proximal humerus fracture with shoulder dislocation is encountered rarely. Recurrent dislocations results in chronic glenoid bones loss which needs fixation along with fracture. Addressing both sides subsequently or in a single sitting is still debatable.