Deivert Kyle T, van der List Jelle P, Trasolini Nicholas A, Waterman Brian R
Atrium Health Wake Forest Baptist, Department of Orthopaedic and Sports Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Video J Sports Med. 2024 Jun 11;4(3):26350254241226724. doi: 10.1177/26350254241226724. eCollection 2024 May-Jun.
True confirmed posterior shoulder dislocations are relatively uncommon injuries, with an estimated incidence of 1.1 per 100,000 individuals and are initially missed in up to 50% to 80% of cases. There are several treatment options for this injury presentation. In this case, we will focus on reconstruction with osteochondral allograft.
If the cartilage cannot be fixed due to comminution or the cartilage is not viable due to chronicity or impact, osteochondral allograft might be a treatment option. This technique is typically considered for defects involving greater than 35% to 40% of the humeral head.
The anterior defect on the humeral head was exposed on the cadaver specimen. Circular bone plugs were obtained from a distal femur specimen for grafting. Graft sites were prepared with a 15 reamer with an orthogonal approach to avoid oblique entry for a stacked bone plug configuration. Bone plug grafts were placed in the defect via press-fit fixation. The subscapularis is repaired to the lesser tubercle following the reconstruction.
Various studies reported improvement in pain, shoulder range of motion, and patient-reported outcome scores. A small percentage of patients developed allograft necrosis. Patients who received autografts had lower rates of osteoarthritis than patients who received allograft. Rehab protocol can last up to 12 months and begins with restricted range of motions and slowly advancing to isometric movements and gradually increasing range of motion and strengthening.
DISCUSSION/CONCLUSION: Outcomes described in previous studies are limited due to the low incidence of these injuries and small sample size. Missing the initial posterior dislocation as this is often correlated with inferior outcomes when treated in chronic setting. There is a risk of damage to humeral articular cartilage during osteochondral tissue harvesting so care must be taken during tissue harvest. Older, lower-demand patients have been reported to do well with nonoperative treatment, even in the case of a chronic dislocation, so careful discussion with the patient is needed to not perform surgery in a reasonably functioning non-painful shoulder.
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
真正确诊的肩关节后脱位相对少见，估计发病率为每10万人中有1.1例，且在高达50%至80%的病例中最初会被漏诊。对于这种损伤表现有多种治疗选择。在本病例中，我们将重点关注同种异体骨软骨移植重建。
如果由于粉碎性骨折软骨无法固定，或者由于慢性损伤或撞击软骨无活力，同种异体骨软骨移植可能是一种治疗选择。该技术通常用于涉及肱骨头35%至40%以上的缺损。
在尸体标本上暴露肱骨头的前部缺损。从股骨远端标本获取圆形骨栓用于移植。用15号扩孔钻以正交入路准备移植部位，以避免倾斜进入形成堆叠骨栓结构。通过压配固定将骨栓移植物置入缺损处。重建后将肩胛下肌修复至小结节。
各种研究报告称疼痛、肩关节活动范围和患者报告的结果评分均有改善。一小部分患者发生了移植物坏死。接受自体移植的患者骨关节炎发生率低于接受同种异体移植的患者。康复方案可持续长达12个月，开始时活动范围受限，然后逐渐进展到等长运动，逐渐增加活动范围并加强锻炼。
讨论/结论：由于这些损伤的发病率低且样本量小，先前研究中描述的结果有限。漏诊初始后脱位，因为在慢性情况下治疗时这通常与较差的结果相关。在获取骨软骨组织时存在损伤肱骨关节软骨的风险，因此在组织获取过程中必须小心。据报道，年龄较大、需求较低的患者即使在慢性脱位的情况下，非手术治疗效果也较好，因此需要与患者仔细讨论，对于功能正常且无疼痛的肩关节不要进行手术。
作者证明已从本出版物中出现的任何患者处获得同意。如果个体可能被识别，作者已随本提交的出版物包含患者的豁免声明或其他书面批准形式。
