Chronic anterior dislocation of the shoulder

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Traumatology

Background:

• Chronic unreduced anterior shoulder dislocations present a significant clinical challenge.
• These dislocations often lead to severe functional deficits and glenoid erosion.
• Previous treatment strategies for chronic dislocations have varied, with limited data on complex reconstructions.

Purpose of the Study:

• To review the outcomes of surgical and nonoperative treatments for chronic anterior shoulder dislocations.
• To evaluate the effectiveness of complex reconstructive techniques, including bone grafting and arthroplasty.

Main Methods:

• Retrospective review of 17 patients (11 female, 6 male; average age 67 years) with chronic anterior shoulder dislocations (average duration 2.3 years).
• Ten patients underwent surgery: open reduction with bone grafting (1) or unconstrained shoulder arthroplasty (9).
• Seven patients were managed nonoperatively due to health or motivation.

Main Results:

• Surgical group: 4 excellent, 4 satisfactory, 1 unsatisfactory outcome after 2-6 years follow-up (average 3.9 years).
• Surgical reconstructions often required bone grafting for glenoid defects and rotator cuff repair.
• Nonoperative group experienced severe functional deficits.

Conclusions:

• Surgical treatment, despite its complexity, yields significantly superior results compared to nonoperative management for chronic anterior shoulder dislocations.
• Advanced techniques like bone grafting and shoulder arthroplasty are effective in managing glenoid erosion and restoring function.
• Careful patient selection and tailored rehabilitation are crucial for optimizing outcomes in these challenging cases.