TUS SINAVINA HAZIRLANAN BİR MESLEKTAŞIMIZDA UYARICI İLAÇLARLA İNDÜKLENEN EPİLEPSİ NÖBETİ SONRASI KİLİTLİ POSTERIOR OMUZ KIRIKLI ÇIKIĞI

Öz

Posterior omuz çıkığı nadir bir durumdur ve humerus başında ters Hill-Sachs lezyonuna yol açabilir. Humeral baştaki defekt eklem yüzünün %20’sinden fazlasını oluşturuyorsa omuz iç rotasyonunda instabiliteye yol açar. Bu durumda kapalı redüksiyon sağlansa da stabilizasyon için cerrahi gerekir. Biz burada uyanıklık sağlayan ve etki mekanizması tam bilinmeyen bir ajan olan modafilin kullanan Tıpta Uzmanlık Sınavına (TUS) hazırlanan bir meslektaşımızda görülen, ilacın indüklendiğini düşündüğümüz epilepsi nöbeti sonrası kilitli posterior omuz kırıklı çıkığında uyguladığımız otolog kemik greftlemeyle başarılı tedavi ettiğimiz olgumuzu sunduk. Diğer tekniklerden farklı olarak anatomik restorasyonu sağlayan bu tekniğin özellikle genç aktif hastalarda akut dönemde uygulanması gerektiğini düşünüyoruz. Biz greftleme dışındaki seçeneklerin normal fizyolojiye uygun olmayan girişimler olduğundan, greftleme gibi daha basit ve fizyolojik bir yöntemde başarı sağlanamıyan hastalar olursa bunların geç dönem rekonstrüksiyonlarda kurtarıcı ameliyat olarak saklanması gerektiği fikrine sahibiz. Otogreft kullanımında döner saha sorunu dezavantaj oluşturuyorsa da tarif ettiğimiz greft alma yöntemiyle bunun en aza indirileceğini düşünüyoruz.

Anahtar Kelimeler

• Kemik grefti
• kilitli posterior omuz çıkı ı
• modafilin
• nöbet
• Ters Hill-Sachs lezyon

TUS SINAVINA HAZIRLANAN BİR MESLEKTAŞIMIZDA UYARICI İLAÇLARLA İNDÜKLENEN EPİLEPSİ NÖBETİ SONRASI KİLİTLİ POSTERIOR OMUZ KIRIKLI ÇIKIĞI

Öz

Posterior dislocation of the shoulder joint is a rare condition which may cause a reverse Heel- Sachs lesion. If the defect in the humeral head is more than 20%, it will result in instability during the internal rotation; in that case even if the joint closely reduced the surgical stabilization will be necessary. In this case we report a case of locked posterior, fracture- dislocation of the shoulder joint in a medical doctor secondary to a seizure (epileptic) attack induced by an alerting agent, with unknown mechanism of action, called Modafilin, which he used during the preparation for the TUS exam. The case was managed surgically using autologus bone graft and internal fixation. The current technique, unlike previous procedures, provides anatomic restoration and we think that it should be applied in young and active patients. We think that, choices other than grafting are non-physiological and should be used as a salvage method for late cases following graft failure. Although graft harvesting is a disadvantage, the method of graft harvesting which we used will minimize the disadvantages. 

Anahtar Kelimeler

• Bone grafting
• locked posterior shoulder dislocation
• modafilin
• seizure
• reverse Hill-Sachs lesion

Kaynakça

1. 1. Hawkins RJ, Mccormack RG. Posterior shoulder instability.Orthopedics. 1988;11(1):101–7.
2. 2. Heller KD, Forst J, Forst R, Cohen B. Posterior dislocation of the shoulder: recommendations for a classification. Arch Orthop Trauma Surg. 1994;113(4):228-31.
3. 3. Brown RJ. Bilateral dislocation of the shoulders. Injury. 1984;15(4):267-73.
4. 4. Kelly JP. Fractures complicating electroconvulsive therapy and chronic epilepsy. J Bone Joint Surg Br. 1954;36(1):70-9.
5. 5. Mestdagh H, Maynou C, Delobelle JM, Urvoy P, Butin E. Traumatic posterior dislocation of the shoulder in adults. Apropos of 25 cases. Ann Chir. 1994;48(4):355-63.
6. 6. Miller BG, Lynch B. Excellent long-term results for acute operative management of locked posterior shoulder dislocation. ANZ J Surg. 2007;77(1-2):95.
7. 7. McLaughlin HL. Posterior dislocation of the shoulder. J Bone Joint Surg Am. 1952;24(3):584-90.
8. 8. Seebauer L, Keyl W. Posterior shoulder joint instability. Classification, pathomechanism, diagnosis, conservative and surgical management. Orthopade. 1998;27(8):542-55.

9. 9. Khayal T, Wild M, Windolf J. Reconstruction of the articular surface of the humeral head after locked posterior shoulder dislocation: a case report. Arch Orthop Trauma Surg. 2009;129(4):515-9.
10. 10. Hawkins RJ, Neer CS 2nd, Pianta RM, Mendoza FX. Locked posterior dislocation of the shoulder. J Bone Joint Surg Am. 1987;69(1):9-18.
11. 11. Porteous MJ, Miller AJ. Humeral rotation osteotomy for chronic posterior dislocation of the shoulder. J Bone Joint Surg Br. 1990;72(3):468-9.
12. 12. Vukov V. Posterior dislocation of the shoulder with a large anteromedial defect of the head of the humerus. A case report. Int Orthop. 1985;9(1):37-40.
13. 13. Weber BG, Simpson LA, Hardegger F. 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.
14. 14. Cheng SL, Mackay MB, Richards RR. Treatment of locked posterior fracturedislocations of the shoulder by total shoulder arthroplasty. J Shoulder Elbow Surg. 1997;6(1):11-7.
15. 15. Chen CR, Qu WM, Qiu MH, Xu XH, Yao MH, Urade Y, Huang ZL. Modafinil exerts a dosedependent antiepileptic effect mediated by adrenergic alpha1 and histaminergic H1 receptors in mice. Neuropharmacology. 2007;53(4):534
16. 16. Fronek J, Warren RF, Bowen M. Posterior subluxation of the glenohumeral joint. J Bone Joint Surg Am. 1989;71(2):205-16.
17. 17. Hawkins RJ, Janda DH. Posterior instability of the glenohumeral joint. A technique of repair. Am J Sports Med. 1996;24(3):275-8.
18. 18. Pollock RG, Bigliani LU. Recurrent posterior shoulder instability. Diagnosis and treatment. Clin Orthop Relat Res. 1993;(291):85-96.
19. 19. Pollock RG, Owens JM, Flatow EL, Bigliani LU. Operative results of the inferior capsular shift procedure for multidirectional instability of the shoulder. J Bone Joint Surg Am. 2000;82(7):919-28.
20. 20. Gerber C, Lambert SM. Allograft reconstruction of segmental defects of the humeral head for the treatment of chronic locked posterior dislocation of the shoulder. J Bone Joint Surg Am. 1996;78(3):376-82.
21. 21. Hughes M, Neer CS 2nd. Glenohumeral joint replacement and postoperative rehabilitation. Phys Ther. 1975;55(8):850-8.
22. 22. Gavriilidis I, Magosch P, Lichtenberg S, Habermeyer P, Kircher J. Chronic locked posterior shoulder dislocation with severe head involvement. Int Orthop. 2010;34(1):79-84.
23. 23. Diklic ID, Ganic ZD, Blagojevic ZD, Nho SJ, Romeo AA. Treatment of locked chronic posterior dislocation of the shoulder by reconstruction of the defect in the humeral head with an allograft. J Bone Joint Surg Br. 2010;92(1):71-6.
24. 24. Bock P, Kluger R, Hintermann B. Anatomical reconstruction for Reverse Hill-Sachs lesions after posterior locked shoulder dislocation fracture: a case series of six patients. Arch Orthop Trauma Surg. 2007;127(7):543-8.
25. 25. Duralde XA, Fogle EF. The success of closed reduction in acute locked posterior fracturedislocations of the shoulder. J Shoulder Elbow Surg. 2006;15(6):701-6.