KRONİK KİLİTLİ ÖNE OMUZ ÇIKIĞI İÇİN KOMBİNE CERRAHİ: LİTERATÜR DERLEMESİ VE OLGU SUNUMU

Year 2015, Volume: 4 Issue: 1, 39 - 45, 30.04.2012

Ali Turgut Burak Günaydın , Seydi Ahmet Eren Önder Kalenderer

Abstract

Omuz çıkıkları sıklıkla eğer 3 haftadan daha eski ise kronik olarak adlandırılmaktadırlar. Bu çıkıkların çoğuna büyük Hill-Sachs lezyonları, glenoid kavite kemik kayıpları ve nörolojik yaralanmalar eşlik edebilir. Bizim olgumuz 66 yaşında bir bayan ve düşme sonucu başvurduğu merkezde sadece Radius alt uç kırığı olarak tedavi edilmiş, öne omuz çıkığı atlanmış. Kronik kilitli öne omuz çıkığının sonucu olarak büyük bir Hill-Sachs lezyonu olduğu saptandı. Yaralanmadan yetmiş gün sonra hastanın omuz rahatsızlığından (ağrı ve hareket kısıtlılığı) dolayı hastaya tedavi olarak; açık redüksiyon, Latarjet Prosedürü ve proksimal humeral içe döndürme osteotomisi uygulandı. Bu tedavi kombinasyonu kronik omuz çıkığı için İngilizce literatürde bir ilktir. Bir yıl sonra hasta ameliyat sonucundan oldukça memnun kalmıştır. Hasta fonksiyonel omuz hareketini kazanmış ve omzunun instabilite olmadan ağrısız olduğu saptanmıştır. Büyük Hill-Sachs lezyonları yaşlı hastalarda genel olarak hemiartroplasti ile tedavi edilmektedir ancak hastanın kendi kemiği korunarak da başarılı sonuç alınabilir.

Keywords

Omuz çıkığı, kronik

A COMBINED SURGERY FOR CHORONIC LOCKED ANTERIOR SHOULDER DISLOCATION: CASE REPORT AND REVIEW OF THE LITERATURE

Abstract

Shoulder dislocations are commonly named chronic if it is older than 3 weeks. Many of these dislocations can be complicated by large Hill-Sachs lesions, glenoid cavity bone loss and neurologic injuries. Our case is 66 years old female and she had been treated only as distal radius fracture by a center and anterior shoulder dislocation was missed. As a result of chronic locked anterior locked dislocation, she had a large Hill-Sach lesion. Seventy days after injury; because of the patient’s shoulder discomfort (pain and limited motion) we performed open reduction, Latarjet Procedure and proximal humeral internally rotating osteotomy as a treatment. This type of treatment for chronic anterior dislocation is used firstly by us in English literature. After one year the patient was satisfied with the result. She gained functional motion and she was pain free without shoulder instability. Large Hill-Sach lesions are commonly treated by hemiarthroplasty if the patient is elderly. But preserving patients own bone can be successful too.

Keywords

Shoulder dislocation, chronic

References

• 1. Korhan Özkan, Koray Ünay, Hakan Çift, Barıs Kadıoglu, Yalçın Turhan, Engin Eceviz; Surgical management of chronic, unreduced anterior dislocation of the shoulder. Eur J Orthop Surg Traumatol 2010; 20:657–9.
• 2. Barney L. Freeman. Old Unreduced Dislocations in: S.Terry Canale Editor. Campbell’s Operative Orthopaedics Vol. 3,10th Edition. Philadelphia,Mosby; 2003.p. 3200-7.
• 3. Schulz TJ Jr ,Unrecognized dislocation of the shoulder. J Trauma 1969; 9: 1009–23.
• 4. Goga IE, Chronic shoulder dislocations. J Shoulder Elbow Surg 2003; 12(5):446–50.
• 5. Rowe CR, Zarins B, Chronic unreduced dislocations of the shoulder. J Bone Joint Surg Am (1982) 64(4):494–505.
• 6. Souchon E, Operative treatment of irreducible dislocation of the shoulder joint, recent or old, simple or complicated. Trans Am Surg Assoc 1891; 15: 311–442.
• 7. F. Mancini, R. Postacchini, R. Caterini; Asymptomatic anterior shoulder dislocation of 24-year duration. J Orthopaed Traumatol 2008; 9: 213–6
• 8. Hejna WF, Fossier CH, Goldstein TB, Ray RD. Ancient anterior dislocations of the shoulder. In: Proceedings of the American Academy of Orthopaedic Surgeons. J Bone Joint Surg Am 1969;51: 1030-1.
• 9. Bennet GE ,Old dislocation of the shoulder. J Bone Joint Surg 1936; 18: 594–606.
• 10. Mehta V. Humeral head plasty for a chronic locked anterior shoulder dislocation. Orthopedics 2009; Jan;32(1):52.
• 11. Pritchett JW, Clark JM, Prosthetic replacement for chronic unreduced dislocations of the shoulder. Clin Orthop Relat Res 1987; 216: 89–93.
• 12. Marinel Drignei, Marius M. Scarlat; Treatment of chronic dislocations of the shoulder by reverse total shoulder arthroplasty: a clinical study of six cases. Eur J Orthop Surg Traumatol 2009;19: 541–6.
• 13. Key JA, Quoted by: Steinderl A. Traumatic deformities and disabilities of the upper extremity. Charles C. Thomas, (1946) Springfield pp 155–61.
• 14. Mosely HF (1969) Shoulder lesions. 3rd edn. Livingstone, Edimburgh pp. 155–61.
• 15. Orhan Akıncı, Cemil Kayalı, Yavuz Akalın; Open reduction of old unreduced anterior shoulder dislocations: a case series including 10 patients. Eur J Orthop Surg Traumatol 2010; 20: 123–9.
• 16. McLaughlin HL (1959) Injuries of the shoulder and arm. In: McLaughlin HL (ed) Trauma. WB Saunders, Philadelphia, pp 233–96.
• 17. David T. Schroder, Matthew T. Provencher, Timothy S. Mologne, Michael P. Muldoon, Jay S. Cox; The Modified Bristow Procedure for Anterior Shoulder Instability 26-Year Outcomes in Naval Academy Midshipmen. The American Journal of Sports Medicine, 2006 Vol. 34, No. 5 , p:778-86.
• 18. Allain J, Goutallier D, Glorion C. Long-term results of the Latarjet procedure for the treatment of anterior instability of the shoulder. J Bone Joint Surg Am. 1998;52: 841-52.
• 19. Hovelius L, Sandstrom B, Rosmark D, Saebo M, Sundgren K, Malmqvist B. Long-term results with the Bankart and Bristow-Latarjet procedures: recurrent shoulder instability and arthropathy. J Shoulder Elbow Surg. 2001;10: 445-52.
• 20. Singer G, Kirkland P, Emery R. Coracoid transposition for recurrent anterior instability of the shoulder. J Bone Joint Surg Br. 1995;77: 72-6.
• 21. Cemil Kayalı, Haluk Ağuş, Önder Kalenderer, Ali Turgut, Tuna İmamoğlu; Overlooked Posterior Shoulder Dislocation: Preoperative and Postoperative CT Studies. A Case Report. Orr ttopediia Traumatologia Rehabilitacja 2009; 2(6); Vol. 11, 177-82.
• 22. B.G. Weber, L.A. Simpson, F. Hardegger, S. Gallen; Rotational humeral osteotomy for recurrent anterior dislocation of the shoulder associated with a large Hill-Sachs lesion. J Bone Joint Surg Am. 1984; 66(9): 1443-50.