Fracture of the proximal humerus metaphysis with coexistent dislocation of the shoulder in children is a rare injury. The injury often occurs as a consequence of high velocity trauma. Most fractures of the proximal humerus commonly associated with the epiphysis in children can be treated with closed reduction. We presented a case of 5-year-old girl who sustained this type of fracture- dislocation of the shoulder. Open reduction and internal fixation with multiple smooth K-wires was performed. At two years follow-up, the patient was pain free and regained full range of motion.
Child, Preschool ; Female ; Fracture Fixation, Internal ; Humans ; Shoulder Dislocation ; complications ; therapy ; Shoulder Fractures ; complications ; surgery

Although fracture of the humeral shaft or dislocation of the shoulder joint is a common injury, a simutaneous injury is rare. We present such a case combined with head injury which took precedence over the skeletal injuries. The postoperative rehabilitation was slowed down by the head injury. This case report makes us aware of some problems when managing the patient with this rare injury and helps us understand the management options better. Also the need for proper follow-up and rehabilitation is emphasized.
Adult ; Craniocerebral Trauma ; complications ; Fracture Fixation, Internal ; Humans ; Humeral Fractures ; complications ; surgery ; Male ; Shoulder Dislocation ; complications

Paralabral cyst of the shoulder joint can be observed in 2% to 4% of the general population, particularly in men during the third and fourth decade. On average, these cysts measure 10 mm to 20 mm in diameter and are located preferentially on the postero-superior aspect of the glenoid. The MRI has increased the frequency of the diagnosis of paralabral cysts of the shoulder joint. Paralabral cysts of the shoulder joint usually develop in the proximity of the labrum. The relationship between shoulder instability and labral tears is well known, however, the association of shoulder instability with a paralabral cyst is rare. Shoulder instability may cause labral injury or labral injury may cause shoulder instability, and then injured tear develops paralabral cyst. In our patient, the inferior paralabral cyst may be associated with inferior labral tears and instability MRI.
*Arthroscopy ; Cysts/complications/*diagnosis/surgery ; Humans ; Joint Instability/complications/surgery ; *Magnetic Resonance Imaging ; Male ; Shoulder Dislocation/complications/surgery ; *Shoulder Joint/pathology/surgery ; Young Adult

OBJECTIVE: To investigate clinical outcomes of countertraction method in treating irreducible subcoracoid dislocation of shoulder joint combined with Hill-Sacks injury. METHODS: A total of 56 patients with irreducible subcoracoid dislocation of the shoulder joint combined with Hill-Sacks injury admitted from December 2013 to June 2020 were retrospectively analyzed. Under the anesthesia of shoulder joint cavity injection, the reduction was performed by using anti-traction method (experimental group) and traditional Hippocrates method (control group), 28 cases in each group. There were 11 males and 17 females in experimental group, with an average age of (61.95±19.32) years old, 9 cases on the left side, and 19 cases on the right side. Twelve males and 16 females in control group, with an average age of (63.13±12.75) years old, 11 cases on the left side, 17 cases on the right side. The curative effects between two groups were evaluated before and after operation, including the success rate of reduction, the duration of reduction, the distance from successful reduction to injury, complications and functional rehabilitation(Constant score of shoulder joint). RESULTS: The success rates of reduction in experimental group and control group were 92.86%(26/28) and 67.86% (19/28), respectively, and the difference was statistically significant (P<0.05). The duration of simple reduction was (4.25±2.13) min and ( 6.31±1.69) min, the difference was statistically significant (P<0.05);the time from successful reduction to injury was (9.16±0.94) h and (8.94±1.31) h, respectively, with no significant difference(P>0.05). There were no complications such as vascular nerve injury and fracture in experimental group, 2 cases of axillary nerve injury and 1 case of humeral head fracture in control group. Constant scores of shoulder joint between experimental group and control group were (92.34±5.62) points and (90.91±4.73) points, respectively, with no significant difference (P>0.05). CONCLUSION For patients with irreducible subcoracoid dislocation of the shoulder joint with Hill-Sacks injury, the countertraction method under anesthesia of the shoulder joint cavity achieved a higher success rate and few complications.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Shoulder Joint/surgery* ; Shoulder Dislocation/complications* ; Retrospective Studies ; Shoulder Injuries ; Joint Dislocations/complications* ; Joint Instability/surgery*

Musculoskeletal injuries following seizures have a high morbidity and mortality. These injuries are often missed and the diagnosis is delayed due to a lack of clinical suspicion and appropriate investigations.We report a case of 72 years old male with simultaneous bilateral central acetabular fracture dislocation and bilateral posterior shoulder fracture dislocation secondary to an epileptic seizure. Present study high- lights the significance of clinical suspicion and clinico-radiological evaluation for diagnosis of a rare injury following episode of seizures. Simultaneous fracture dislocation of all four limbs treated with a holistic approach can lead to a good functional recovery. Surgical management with open reduction and internal fixation is preferred and replacement arthroplasty should be reserved for cases with implant failure and elderly patients.
Acetabulum ; injuries ; Aged ; Epilepsy ; complications ; Fracture Dislocation ; diagnostic imaging ; surgery ; Fractures, Bone ; surgery ; Humans ; Male ; Shoulder Fractures ; diagnostic imaging ; surgery

Posterolateral rotatory instability of the elbow describes a condition that radial head subluxation or dislocation occurs when forearm rotates externally in relation to humerus. It is difficult to diagnose and treat. We reported a typical case which was confirmed by physical examination and MR images. Ligamentous insufficiency was confirmed under direct vision, and was reconstructed with triceps fascia as described by Gong et al with slight modification. Regain of full function was achieved one year after surgery.
Adult ; Elbow Joint ; physiopathology ; Female ; Humans ; Joint Instability ; complications ; diagnosis ; physiopathology ; surgery ; Magnetic Resonance Imaging ; Shoulder Dislocation ; complications

Posterior shoulder dislocation is a rare event that may occur after a direct trauma, an epileptic seizure, electric shock or electroconvulsive therapy. In more than 50% of the cases, posterior dislocations are missed on initial evaluation and often misdiagnosed as frozen shoulders with unfortunate consequences. We present the case of a missed posterior subluxation and reverse Hill Sachs lesion (McLaughlin lesion) in a 40-year-old woman caused by anelectric shock of 240 V. The patient underwent surgery in our institute two weeks after the injury. The humeral head was reduced and the reverse Hill Sachs lesion was filled by demineralized bone matrix allograft with osteoinductive factors. Tendons were repaired and a temporaneous artrodesis was performed. At the final follow up of 12 months, we obtained a Costant Score of 93 and the patient returned to her previous daily activities.
Adult ; Diagnostic Errors ; Disability Evaluation ; Electric Injuries ; complications ; diagnosis ; surgery ; Female ; Humans ; Shoulder Dislocation ; diagnosis ; etiology ; surgery

INTRODUCTION: Arthroscopic Bankart repair is a widely accepted procedure to treat recurrent shoulder dislocation. This study aims to describe our experience with arthroscopic Bankart repair and its functional outcome. METHODS: 107 patients who underwent arthroscopic Bankart repair from 2008 to 2013 were followed up for a minimum of three years and reviewed by an independent observer. 80 consented to being interviewed using the Oxford Shoulder Instability Score (OSIS) and Simple Shoulder Test. RESULTS: 82 shoulders (two bilateral) were studied. Mean age at first dislocation was 19.4 ± 3.4 (12.0-31.0) years. Mean follow-up was 4.4 ± 1.3 (3.0-9.0) years and 2.5 ± 3.0 (0.1-15.4) years elapsed from first dislocation to surgery. 41 (50.0%) patients played overhead or contact sports and 44 (53.7%) played competitive sports before injury; 8 (9.8%) patients reported recurrence of dislocation, which was significantly associated with playing competitive sports before injury (p <0.039), 5 (6.1%) underwent revision surgery and 22 (26.8%) reported residual instability after surgery. 49 (59.8%) patients returned to playing sports, 75 (91.5%) were satisfied with their surgery and 79 (96.3%) were willing to undergo the surgery again. 74 (90.2%) patients had two-year good/excellent OSIS, which was significantly associated with playing competitive sports before injury (p = 0.039), self-reported stability after surgery (p = 0.017), satisfaction with surgery (p = 0.018) and willingness to undergo surgery again (p = 0.024). CONCLUSION Arthroscopic Bankart repair yields good functional outcomes and is associated with high patient satisfaction, although not all patients return to sports.
Humans ; Adolescent ; Young Adult ; Adult ; Shoulder Dislocation/complications* ; Joint Instability/surgery* ; Shoulder Joint/surgery* ; Return to Sport ; Patient Satisfaction ; Retrospective Studies ; Recurrence ; Arthroscopy/methods*

OBJECTIVETo investigate the clinical effects of internal fixation with double endobutton for the treatment of acromioclavicular joint dislocation of Tossy Grade III.

METHODSFrom 2007.7 to 2008.12, 27 patients with acromioclavicular joint dislocation of Tossy Grade III were fixed with double endobutton. Among the patients, 17 patients were male and 10 patients were female, with an average age of (35.0 +/- 1.3) years (ranged from 23 to 60 years). Fourteen patients were injured by traffic accident, 6 patients were work-related injuries, 4 patients were sports injuries, and 3 patients were injured by falling down. Sixteen patients had injuries in the left, and 11 patients in the right. All the patients were Tossy III type dislocation without clavicle fracture. The therapeutic effects were evaluated by Karlsson criteria based on range of motion of acromioclavicular joint, pain, muscle force and postreduction X-ray.

RESULTSAll the patients were followed up for 6 to 14 months, mean 10.2 months. According to the Karlsson score criteria, 24 patients obtained an excellent result, 2 fair and 1 poor.

CONCLUSIONFixation with double endobutton is to be a new method for the treatment of acromioclavicular joint dislocation, which has the advantages of minimal trauma, reliable fixation, early functional rehabilitation and so on.

Acromioclavicular Joint ; injuries ; surgery ; Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Internal Fixators ; Male ; Middle Aged ; Postoperative Complications ; Shoulder Dislocation ; surgery ; Treatment Outcome ; Young Adult

INTRODUCTIONThe purpose of this study is to compare the sensitivities and positive predictive values (PPV) of the anterior apprehension test and magnetic resonance imaging (MRI) in the diagnosis of anterior labral tears in young patients with shoulder instability and to determine if surgery could be carried out without this investigation in selected patients.

MATERIALS AND METHODSWe undertook a retrospective study of 168 patients aged between 15 and 30 years with a history of shoulder dislocation and compared the sensitivities and the PPV of the apprehension test with both MRI and magnetic resonance arthrograms (MRA) in the diagnosis of a Bankart lesion. The radiological investigations were interpreted by general practice radiologists and specialised musculoskeletal radiologists. All patients had their diagnosis confirmed by shoulder arthroscopy.

RESULTSOur results showed that the apprehension test was highly reliable when it was positive with a PPV of 96%. It was more sensitive than MRI in the diagnosis of a Bankart lesion. The clinical test was significantly better when a musculoskeletal radiologist interpreted the MRI. The MRA interpreted by a musculoskeletal radiologist had the highest rates of sensitivity in detecting Bankart lesions. The figure was similar to that for the apprehension test. There was no difference in the PPVs among the clinical test, the MRI and the MRA read by the 2 categories of radiologists.

CONCLUSIONWe conclude that a routine MRI may be unnecessary in evaluating a young patient with clinically evident anterior shoulder instability if the apprehension test is positive. A MRA that can be interpreted by a musculoskeletal radiologist will be the next best investigation if the clinical test is negative or equivocal.

Adolescent ; Adult ; Arthroscopy ; Female ; Humans ; Joint Instability ; diagnosis ; etiology ; surgery ; Magnetic Resonance Imaging ; Male ; Physical Examination ; methods ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; Shoulder Dislocation ; complications ; diagnosis ; surgery ; Shoulder Joint ; surgery ; Young Adult