[Latarjet procedure for the treatment of inveterated shoulder dislocations]

Transfer of the tip of the coracoid process to the anterior margin of the glenoid is a procedure indicated in shoulder instability due to bone lesion. However, it is also used in inveterated shoulder dislocations refractory to conservative treatment that require open reduction of the joint. The bone block thus created allows for more effective and safer rehabilitation than does a temporary rigid Ki-wire fixation of the humeral head. The aim of this retrospective study was to evaluate the group of patients treated for irreducible inveterated shoulder dislocations by the Latarjet procedure.

Between 2005 and 2009, 16 patients with inveterated anterior shoulder dislocations were operated on. The group comprised 11 men and five women with an average age of 58 years. In all patients the duration of shoulder dislocation was longer than 3 days and reduction that would keep the humeral head in the glenoid socket was not possible even under general anaesthesia. The reasons for the late treatment included a delayed visit to the doctor's because the injury was not considered serious, the dislocation being missed in the presence of other more serious conditions, and even an overlooking by the attending physician. The longest time between the dislocation and its treatment was 23 days. Alcohol abuse was evident in some of the patients.

In the patients with irreducible inveterated shoulder dislocations who were referred to us, closed reduction was attempted in the first place.When this failed or when spontaneous dislocation subsequently occurred, open revision surgery was carried out. After coagula and synovia were removed from the glenoid socket, the head still had a tendency to dislocate spontaneously. Subsequently, the Latarjet procedure ;was performed this involved osteotomy of the coracoid process, retaining the attachment of the short head of the biceps brachii, and its transposition, through a split in the subscapularis ten- don, to the anterior lower margin of the glenoid. The process was fixed with two traction screws to create a firm bone barrier preventing dislocation.

The functional outcome was assessed at 6 months after surgery, ;using the Constant score its average value was 60 points (35 to 85). From the evaluation of individual cases it appeared that the longer the time of shoulder dislocation, the worse the functional outcome of treatment. In comparison with the patients treated by open reduction with a temporary rigid Ki-wire fixation, the Latarjet procedure was clearly beneficial.

Before the Latarjet procedure has been adopted, inveterated dislocations were treated by open reduction and a temporary fixation of the head in the socket by means of Ki-wires for three weeks. The functional outcomes following inveterated dislocation and rigid fixation were pitiable. Although the shoulder was articulated, its motion was restricted and painful. The procedure described here allows the patient to start early rehabilitation while maintaining shoulder stability.

Inveterated irreducible shoulder dislocation is a rare diagnosis which is usually associated with the patient's personality disorder or is missed in patients with a disorder of consciousness. The treatment is difficult, but with the use of the procedure described here it is possible, with some limitation, to restore the shoulder function and its range of motion.