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[Experiences with Weber's subcapital rotation osteotomy in recurrent shoulder dislocation].

In 23 patients suffering from recurrent posttraumatic dislocation of the shoulder joint the derotation of the humeral head was performed as described by Weber. A description of the operative technique is given. As recommended by Weber an angled 1/2-tubular plate with 7 holes was used for stable osteosynthesis 17 times. After movement treatment removal of the osteo-synthesis-material was possible 6 to 8 months later. Because of high absence of recidivity with repair of full mobility and full strength the derotation of the humeral head is a treatment of choice in cases of recurrent posttraumatic dislocation of the shoulder joint.

Adolescent

The epidemiology of shoulder dislocations.

In an urban population of a quarter of a million, all shoulder dislocations that occurred in a 5-year period were recorded. A total of 216 shoulder dislocations were seen, 53.3% in men. The overall incidence rate was 17/100,000 per year. Incidence peaks were found in the age-group 21-30 years among men and in the age-group 61-80 years among women. Significantly more patients in the older age groups, and especially women, dislocated at home by falling on an outstretched arm, whereas the younger age-groups most frequently dislocated outside the home, e.g., on sports fields. A considerable number of patients (18.6%) were hospitalized, and 85.5% of the patients required outpatient follow-up. Prophylactic measures should be taken especially to increase the safety of the elderly in their homes.

Accidental Falls

External rotation method of shoulder dislocation reduction.

We used the external rotation method for reducing anterior shoulder dislocations on 85 consecutive patients seen in our emergency department during a one-year period. In relatively inexperienced hands, the external rotation method was successful on first attempt in 80% of cases. There were no complications attributable to the technique itself. We feel that it is a successful, easy, and atraumatic method of achieving reduction in both first occurrence and recurrent anterior shoulder dislocations.

Adolescent

New traction devices to aid reduction of shoulder dislocations.

A set of traction devices that aid in the reduction of shoulder dislocations is described and their use and efficiency are discussed. A series of 47 consecutive patients seen over a six-month period and diagnosed as having shoulder dislocations with no other major trauma composed the study population. After radiographic confirmation and premedication with analgesics and muscle relaxants, the devices were used. The traction- countertraction method was used initially. When this method was unsuccessful, the Stimson method was performed using an alternate traction strap. These devices were successful in 96% of the relocations attempted. No complications were encountered. The traction devices were found to be effective and easy to use.

Adolescent

[Diagnosis and therapy of traumatic posterior shoulder dislocations].

In cases of dislocation of the shoulder the humeral head almost always dislocates anteriorly. Only rarely does the dislocation result in a posterior position of all or part of the humeral head. The diagnosis of posterior dislocation is not always as easy as the diagnosis of anterior dislocation and for this reason the injury is often missed. Cisternino et al. found that over 50% of patients with posterior dislocation of the shoulder were missed on initial examination. The longer the time between accident and treatment, the more difficult that treatment becomes and the harder it is to achieve a satisfactory functional result. Therefore it is vital to think of this injury in all cases of severe contusion of the shoulder and if there is the slightest suspicion of this injury, the patient must be aggressively investigated to establish the relationship between the humeral head and the glenoid.

Bone Plates

Prognosis of primary anterior shoulder dislocation in young adults.

From 1982 to 1987, 194 patients with 196 primary traumatic anterior shoulder dislocations were treated in our hospital. One hundred and sixty-six patients with 168 shoulder dislocations (87%) were available for study at follow-up an average of 4 years after treatment. The most important prognostic factor in relation to recurrence was the age of the patient at the time of the primary dislocation. The highest recurrence rate was found in patients of 30 years and younger (64%). Athletes in this age group had no worse a prognosis as to recurrence than non-athletes. A fracture of the greater tuberosity improved the prognosis significantly (P less than 0.01). Neither the presence of a Hill-Sachs lesion nor the period of immobilization influenced the recurrence rate in patients aged 30 years and younger.

Adolescent

[Therapeutic procedure in initial traumatic shoulder dislocation (arthroscopy--limbus refixation)].

This is a report of the therapeutic measures following primary traumatic dislocation of the shoulder in young patients (under 40 years of age). In order to rule out a disruption of the glenoid labrum, all patients were subjected to arthroscopy and disruption thus diagnosed in 38 of 48 cases. Surgical refixation of the glenoid labrum was performed on these patients. The ten patients with a stable labrum were given a Gilchrist dressing, immobilizing the shoulder for two to three weeks. Eight of the ten patients who had only had arthroscopy were followed up for an average of three years (two to six years). One developed recurrent dislocation of the shoulder. 31 of 38 patients who had had surgical refixation of the glenoid labrum were followed up for an average of 2.4 years (two to 5.8 years). None of these patients developed recurrent dislocation. Clinically, 25 patients have no pain whatsoever, while five report minor complaints, 30 patients are satisfied with the surgical outcome and only one is not.

Adolescent

[Value of heterologous bone transplants in the surgical therapy of habitual shoulder dislocation].

45 heterologous bone grafts of "Kiel Bone" were radiologically examined after operative treatment of recurrent shoulder dislocation in the technique of M. Lange. The postoperative period differed between 1 and 17 years. Bony consolidation was achieved in 80% of the cases. Signs of resorption were postoperatively found in 14 cases. Five of them consolidated secondaryly. The results of our study show the usefulness of "Kiel Bone" in the treatment of recurrent shoulder dislocation. It should not be used as a bone graft in cases which require quick an secure consolidation. In these cases autologous bone grafts are superior.

Bone Transplantation