Neglected and locked anterior shoulder dislocation: functional outcomes and complications after open reduction and preservation of humeral head.

BACKGROUND

Neglected and locked anterior shoulder dislocation is a rare problem that presents several treatment challenges. Our study aimed to evaluate the functional outcomes and postoperative complications after open reduction and head preservation surgery in patients with neglected and locked anterior shoulder dislocation.

METHODS

Ten patients (age 51 ± 22 years) with a follow-up of 27 months ± 7 months (range 24-40 months) were included in the study. The anteriorly dislocated humeral heads were open and reduced after an average neglect of 10 ± 15 months. The neglected dislocation was classified into two types by the severity of the injury. (1) Type 1: There were no associated severe injuries, and the humeral head was reduced in the glenoid cavity without take-down of the subscapularis (type 1a) (n = 5) or via take-down of the upper half of the subscapularis (type 1b) (n = 2). (2) Type 2: There were associated factors such as a greater tuberosity fracture (n = 2) or a grade 3/4 fatty infiltrated supraspinatus and infraspinatus muscles (n = 1). Complete removal of the subscapularis was necessary to reduce the humeral head.

RESULTS

The pain scores improved from a baseline value of 8 ± 1 to a final value of 1 ± 1 ( < .001), the absolute Constant score improved from a baseline value of 13 ± 8 to a final value of 69 ± 21 ( < .001), elevation range of motion (ROM) improved from a baseline value of 44° ± 43° to a final value of 123° ± 30° ( < .001), external rotation ROM improved from 0° ± 13° to 49° ± 12° ( < .001), and internal rotation ROM improved from sacroiliac joint ± 2 vertebra level to thoracic T11 ± 3 vertebrae level ( < .0001). The final shoulder subjective value was 77 ± 20 and was excellent in 3 patients, good in 5 patients, fair in 1, and poor in 1 patient. Major complications were observed in 30% (n = 3) of patients: persistent humeral head anterior subluxation in 20% (n = 2) of patients and superior migration of the humeral head in 10% (n = 1) of patients.

CONCLUSION

Open reduction and head preservation in patients with neglected anterior dislocation led to good functional outcomes in 70% (as per Constant score) to 80% (as per shoulder subjective value) of the patients. However, we observed major complications such as persistent anterior subluxation (n = 2) and superior head migration (n = 1), leading to suboptimal functional outcomes in cases with associated factors such as a greater tuberosity fracture or severe fatty infiltrated cuff muscles.