Goyal Tarun, Paul Souvik, Sethy Siddharth S, Choudhury Arghya Kundu
Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
J Orthop Case Rep. 2020 Nov;10(8):88-92. doi: 10.13107/jocr.2020.v10.i08.1874.
Chronic posterior dislocation is a very rare injury. Various methods have been described for its treatment. This report describes a rare case of post-traumatic chronic posterior dislocation of the shoulder. Posterior bone block procedure performed through a limited posterior deltoid splitting approach was used with good surgical outcomes. The bone block procedure for chronic posterior dislocation is rarely described in the literature.
A 30-year-old male presented with complaints of pain on movement of the left shoulder and inability to lift the arm overhead for the past 5 months, following a fall from a moving train on his left shoulder. He had been treated conservatively with no improvement in symptoms. On clinical examination, there was a loss of deltoid contour with painful and restricted abduction and external rotation. The shoulder joint could be reduced by bringing the arm in 90o of abduction in the scapular plane. The anteroposterior radiograph showed a positive light bulb sign and a malunited fracture greater tuberosity. Magnetic resonance imaging revealed a reverse Hill-Sachs lesion with intact rotator cuff. Unlike a classical chronically dislocated joint, the shoulder joint was not stiff in this position. The reduction of the joint was possible but was not maintained in the resting position of the limb. Hence, the joint could be reduced intraoperatively, and reduction maintained with a posterior bone block procedure, without any need for further soft-tissue releases. A tricortical iliac crest bone graft was used as the bone block.
Chronic posterior dislocation of the shoulder is a rarely reported entity, which can be easily missed in clinical examination. The limited deltoid splitting approach is a safe approach with excellent exposure of posterior glenoid rim. Posterior bone block procedure is a viable reconstructive option in treating cases of chronic posterior dislocation.
慢性后脱位是一种非常罕见的损伤。已经描述了多种治疗方法。本报告描述了一例创伤后慢性肩关节后脱位的罕见病例。采用经有限后三角肌劈开入路进行的后骨块手术，取得了良好的手术效果。慢性后脱位的骨块手术在文献中很少被描述。
一名30岁男性，因左肩从行驶的火车上跌落，在过去5个月中出现左肩活动时疼痛，无法将手臂举过头顶。他接受了保守治疗，但症状没有改善。临床检查发现三角肌轮廓消失，外展和外旋疼痛且受限。在肩胛平面将手臂外展90°时，肩关节可以复位。前后位X线片显示阳性灯泡征和大结节骨折畸形愈合。磁共振成像显示有反向Hill-Sachs损伤，肩袖完整。与典型的慢性脱位关节不同，该肩关节在这个位置并不僵硬。关节可以复位，但在肢体休息位时不能维持。因此，术中可以将关节复位，并通过后骨块手术维持复位，无需进一步松解软组织。采用三面皮质髂嵴骨移植作为骨块。
肩关节慢性后脱位是一种很少报道的疾病，在临床检查中很容易被漏诊。有限三角肌劈开入路是一种安全的入路，能很好地暴露后盂缘。后骨块手术是治疗慢性后脱位病例的一种可行的重建选择。
