Chamseddine Ali H, Mouchantaf Mark E, Freiha Kinan, Asfour Ali, Boushnak Mohammad O
Orthopedic Surgery, Faculty of Medical Sciences, Sahel General Hospital, Lebanese University, Beirut, LBN.
Orthopedic Surgery, Faculty of Medical Sciences, Lebanese University, Beirut, LBN.
Cureus. 2020 Oct 17;12(10):e10996. doi: 10.7759/cureus.10996.
Missed or chronic bilateral anterior shoulder dislocation is a rare presentation, usually secondary to epileptic attack. We present herein an exceptional case of this injury pattern, associated with bilateral displaced fracture of the coracoid process, and unilateral rupture of the long head of biceps. Treatment consisted of open reduction through osteotomy of the lesser tuberosity, with additional stabilization of the glenohumeral joint, using the Latarjet procedure by transposition of the coracoid fragment with its attached conjoint tendon to the antero-inferior glenoid rim. Rupture of the long head of the biceps required tenodesis. Temporary glenohumeral pin transfixation was performed for residual instability at the end of the procedure. Patients with postictal shoulder pain, discomfort, or disability should be investigated with adequate radiographs, in addition to CT scan or MRI when needed. Early diagnosis allows for safe closed reduction, and helps avoid late and more complex surgical treatment required for missed or chronic dislocations.
双侧肩关节前脱位漏诊或慢性双侧肩关节前脱位较为罕见，通常继发于癫痫发作。我们在此介绍一例这种损伤类型的特殊病例，该病例伴有双侧喙突骨折移位以及肱二头肌长头腱单侧断裂。治疗方法包括通过小粗隆截骨进行切开复位，并使用Latarjet手术，即将喙突骨块及其附着的联合腱转位至肩胛盂前下缘，对盂肱关节进行额外固定。肱二头肌长头腱断裂需要进行腱固定术。手术结束时，针对残留的不稳定情况进行了临时盂肱关节穿针固定。对于发作后出现肩部疼痛、不适或功能障碍的患者，除了在必要时进行CT扫描或MRI检查外，还应进行充分的X线片检查。早期诊断有助于进行安全的闭合复位，并有助于避免漏诊或慢性脱位所需的晚期及更复杂的手术治疗。
