Closed Distraction for Chronic Unreduced Anterior Shoulder Dislocations

Abstract

Chronic joint dislocations are a common problem in less-developed countries where many treatment options are unavailable. Closed distraction by external fixation was used successfully to treat neglected chronic dislocations of elbow and later shoulder joints. Ilizarov has demonstrated that elongation of soft tissues can be achieved by continuous distraction of about 1 mm per day. A small series of only four consecutive patients, three males and one female (age range: 26-39 years) presenting with unreduced anterior shoulder dislocations, was treated with distraction of the humeroscapular joint. The duration of dislocation ranged from 88 to 159 days and time in distraction lasted from 22 to 59 days. After reaching sufficient elongation, a small anterior deltoid splitting arthrotomy was performed and in all four patients a large semilunar bony defect of the anterior glenoid rim was repaired with an autologous bone graft removed from the iliac crest followed by immediate passive and active mobilisation postoperatively. The Rowe-Zarins score increased markedly in all patients, the result was excellent in two, good in one and fair in the fourth patient.

Key words

external fixators - unreduced - shoulder dislocation - distraction - Ilizarov - developing countries

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