[Chronic anterior shoulder dislocation treated by open reduction sparing the humeral head]

Treatment options for unreduced anterior dislocation of the shoulder have varied from nonoperative treatment to different surgical options. Little has been written in the literature on the management of unreduced anterior dislocation or on the results of the different procedures. We report our experience and present the outcome after an open reduction joint-saving procedure used in five patients.

Five patients, mean age 39 years (range 17-69 years) underwent the joint-saving procedure for chronic anterior shoulder dislocation. Pain was predominant for two patients and functional impairment for three. The shoulder had been anteriorly dislocated for six weeks to up to 36 months (average 14 months). Open reduction was performed in all cases with reinsertion of the capsulo-labral complex onto the anterior glenoid rim. A bone graft was used in one patient to reconstruct an anterior glenoid bone defect involving more than half of the joint surface. No graft was used to fill the humeral head defect.

At an average follow-up of 25 months (range 12-36 months), outcome was excellent in one patient, good in three, and poor in one (Rowe and Zarins score). Postoperatively, the overall score averaged 75 points (range 40-90). Pain score improved from 12 to 27 points. Three shoulders were totally pain free and two had mild to moderate pain. Motion improved from 12 to 28 points. Anterior active elevation averaged 126 degrees, external active rotation 17 degrees, and internal active rotation to the level of the first lumbar vertebral body. Functional score improved from 9 to 20 points. All the patients were able to perform daily living activities. The radiographic evaluation showed anterior subluxation of one shoulder one year after surgery. Osteoarthritis was also noted in one patient. No peroperative or postoperative complication was seen.

Unreduced anterior shoulder dislocation should be treated with an open reduction and reconstruction of the specific lesions, unless the patient is old or debilitated. This operation can however be difficult and requires extensive soft tissue release, and occasionally use of a bone graft to reconstruct the anterior defect of the glenoid. The long-term results remain modest. When the humeral head cannot be saved because of extensive osteochondral lesions, shoulder arthroplasty must be the treatment of choice.