Operative Treatment of Chronic Unreduced Dislocation of the Shoulder

Rhee, Yong Girl; Kwon, Byung Ki

Abstract

We experienced four patients that had gone unreduced for at least eight weeks and evaluated the results of the operative treatment in these paitents. All four cases were anterior dislocation, and among them three cases were dislocated by direct trauma and one was dislocated during seizure attack. Pain was moderate in one case and mild in three cases. In the preoperative range of motion, the average passive tlexion at the scapular plane was 143 degrees (90 degrees - l70 degrees) and average external rotation at the side was 33 degrees(5 degrees-60 degrees), but the average active flexion was 103 degrees, active external rotation was 16 degrees and the internal rotation at the back was the sacral level except one. All four patients complained of severe limitation of daily living activity due to limitation of motion and weakness and could not occupy their jobs. In all four cases, three dimensional CT scan was performed to evaluate glenoid and humeral bone defect and for preoperative planning. Operation was performed at 8 weeks after initial dislocation in two cases, 1 year later in one case and 2 years later in one case. Open reduction was done and the defect of humeral head was filled with osteochondral allograft in two cases. Fractured humeral head fragment was reduced and fixated with non-ahsorhahle suture in one case and prosthetic head replacement was performed in the other. As a result, three patients had a mild or moderate pain postoperatively and moderate functional restrictions in the activities of daily living, and they were considered to be unsatifactory. Two cases were subluxated during the follow-up. These results show that the overall prognosis for the surgical treatment of the chronic unreduced dislocated shoulder is unpredictable and unacceptable.