RESUMO
Neglected unreduced cervical dislocation is very uncommon. In our case (a lady who stayed asymptomatic for 13 months before development of cervicobrachialgia), the anterior reduction/arthrodesis was easy, and we did not find any benefit from an additional posterior procedure thanks to a congenital block between C7 and T1 vertebral bodies. This point is nevertheless a matter of debate. After a review of the literature, we did not find any consensus about the ideal scheme and sequence to reduce and stabilize this delayed type of cervical trauma. We emphasize the need of dynamic radiographies to exclude unstable injuries but also a prereduction MRI (especially in unexaminable patients) to detect any dangerous disc fragment. If there is no visible change in the radiological status while attempting to reduce the dislocation by external maneuvers, there is little chance to reduce it successfully only by a single approach. Therefore, in irreducible delayed dislocations, it seems safer to prepare the reduction/fusion stage (either anterior/posterior, depending on the habits and skills of the surgeon) by a first stage carrying out a release of the fibrous tissues on the opposite side (either posterior to release the facet joints or anterior to release the intervertebral disc), followed by the reduction/fusion stage itself and then by a third stage to lock the level. Like many authors, we recommend an anterior approach first in case of an extruded disc visible on the MRI, and therefore, we show a preference for the anterior-posterior-anterior sequence in irreducible delayed cervical dislocations.
RESUMO
PURPOSE: The main objective of this retrospective study was to analyze the rate and modes of failure of latissimus dorsi transfer (LDT). The secondary objective was to evaluate whether a rupture of the transfer was associated with a worse outcome. METHODS: During a 2-year period, we performed consecutive LDTs either for irreparable posterior-superior rotator cuff tears (RCTs) or for failed prior repair. All the LDTs were performed by a single surgeon. All transfers were arthroscopically assisted and fixed as a tubularized LD tendon in a bone tunnel inside the humeral head. Three metal clips were placed systematically intraoperatively in the tubularized tendon at a fixed distance of 2, 4, and 6 cm from the tip of the tendon. Immediate postoperative standard anteroposterior radiographs were performed and the position of the metal clips was compared with their position on radiographs performed at 6 weeks and 3 and 24 months postoperatively. Constant, Subjective Shoulder Value (SSV), Simple Shoulder Test (SST), Activities of daily living requiring active external rotation (ADLER), visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) scores and patient's subjective satisfaction (assessed by self-questionnaire) at last follow-up were compared between patients who had a rupture of the transfer and those who did not. RESULTS: Sixty-six patients were included. Six of 66 patients (9%) were lost to follow-up. There were 11 complications (18.3%) in the global series (10 hematoma and 1 subscapularis retear). At a mean 35.2 months (range 24-50 months), there were 23/60 cases of rupture (38%). The 7 scores and the satisfaction reported were significantly lower for patients who had a rupture of the transfer versus those who had an intact transfer: Constant score, 42.8 versus 68.7 (P = .001); SSV, 48.9 versus 71.6 (P = .001); SST, 4.8 versus 8.4 (P = .012); ADLER, 19.7 versus 26.7 (P = .005); VAS, 3.7 versus 2.3 (P = .082); ASES, 55.4 versus 74.8 (P = .056); and 13% of either satisfied or very satisfied patients versus 78% (P < .001). CONCLUSIONS: The rate of rupture of LDT is high (38%). With complete healing of LDT, the outcome is significantly lower in those with rupture compared with those without rupture, showing that LDT can efficiently treat massive and irreparable RCT. LEVEL OF EVIDENCE: Level IV, case series treatment study.