Chronic shoulder dislocations.

Area of Science:

• Orthopedic Surgery
• Traumatology
• Sports Medicine

Background:

• Chronic shoulder dislocation is a debilitating condition affecting patients of all ages.
• Previous reports on chronic shoulder dislocations show varied outcomes with different treatment modalities.
• This study focuses on a South African population with a high incidence of anterior subcoracoid dislocations.

Purpose of the Study:

• To evaluate the outcomes of surgical versus non-operative management for chronic shoulder dislocations.
• To assess the efficacy of coracoid transfer and K-wire fixation for chronic anterior shoulder dislocations.
• To report on the incidence of neurovascular complications and the success rate of closed manipulation.

Main Methods:

• Retrospective review of 32 patients diagnosed with chronic shoulder dislocation over 5 years.
• Analysis of patient demographics, dislocation type, duration, associated conditions (epilepsy, neurological deficits), and treatment received.
• Surgical technique involved coracoid transfer to the glenoid with acromiohumeral K-wire fixation for 4 weeks in 10 patients.

Main Results:

• Thirty-one of 32 patients had anterior subcoracoid dislocation; one had posterior dislocation.
• Closed manipulation was successful in only one patient; 10 patients were left unreduced.
• Surgically treated patients (coracoid transfer and K-wire fixation) showed significantly better outcomes compared to those left unreduced, irrespective of dislocation duration or patient age.

Conclusions:

• Surgical intervention, specifically coracoid transfer with K-wire fixation, is superior to non-operative management for chronic shoulder dislocations.
• The described surgical technique achieved successful relocation without neurovascular complications.
• This series emphasizes the rarity of successful closed reduction and the predominantly anterior nature of chronic dislocations in this cohort.