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Mar 28, 2023 •252 likes •684 views

Instability Cases Arthroscopic Rx for 21yr Stabilization now Old Linebacker Open Stabilization with now Nonoperative Subluxation Treatment and Bony Stabilization at end Bankart?? of Season Case Report 21 Yr Old

  2. Instability Cases ฀ Arthroscopic ฀ Rx for 21yr Stabilization now Old Linebacker ฀ Open Stabilization with now ฀ Nonoperative Subluxation Treatment and Bony ฀ Stabilization at end Bankart?? of Season

  3. Case Report ฀ 21 Yr Old All-ACC Linebacker ฀ Subluxation Episode mid-season ฀ MRI Bony Bankart ฀ Completes Season with intermittent symptoms

  6. What Would the Panel Do????

  10. Posterior Approach For Inferior Anchor ฀ Beach Chair Position ฀ Spider Arm Holder ฀ Anterior Viewing ฀ Posteriolateral Axillary Portal ฀ 6:00 Inferior “Home- Run” Anchor

  11. Instability Collision Athlete Summary • Three Anchors • Inferior Anchor From Posteior Approach • Usually 4 total

  13. Case #1: Soccer Player

  14. History 29y, male - First consultation 09.01.2017 - Recurrent ant. inf. dislocations - Exacerbation following fall 2012 - Unknown prior shoulder surgery 2012

  15. X-Ray 09.01.2017

  16. MRI 10.01.2017

  17. Whats wrong?

  18. History 29y, male - First consultation 09.01.2017 - Recurrent ant. inf. dislocations - Exacerbation following fall 2012 - Unknown prior shoulder surgery 2012 - Secondary diagnosis: Epilepsy

  19. Hospitalisation- X-ray 17.01.2017

  20. CT 17.01.2017

  21. CT 17.01.2017

  22. Treatment options?

  23. Comb. Latarjet and post. bone block (17.01.2017 / 07.02.2017)

  24. Comb. Latarjet and post. bone block (17.01.2017 / 07.02.2017)

  25. Comb. Latarjet and post. bone block (17.01.2017 / 07.02.2017)

  26. Comb. Latarjet and post. bone block (17.01.2017 / 07.02.2017)

  27. Comb. Latarjet and post. bone block (17.01.2017 / 07.02.2017)

  28. CT 09.02.2017

  29. Next visit – 26.04.0217 - Recurrent shoulder dislocation due to epileptic seizure - Refused to take anticonvulsant medication (3 days) CT – 09.02.2017 CT – 26.04.2017

  30. CT 26.04.2017

  31. Computed tomography - 26.04.2017

  32. Treatment options?

  33. Surgical procedure – 03.05.2017 - Glenoid augmentation with iliac crest bone block - Secured with two cannulated screws

  34. Case #2: Ice Hockey Player

  35. History 40y, male - 02/2017 fall during ice skating - Reduction by third person - Persistent apprehension sign ++

  36. X-Ray 02/2017

  37. MRI 02/2017

  38. Treatment options?

  39. Modified arthroscopic McLaughlin procedure with bony mosaicplasty Normal Locked posterior dislocation Modified McLaughlin with bony mosaicplasty Reduced

  40. 6w postop. (04/2017)

  41. Strategie 0 % Impression • Konservativ Humerus ? • ASK (instabil) <10 % • Konservativ • ASK McLaughlin Männlich, 40J 10-20 % Posteriore ASK / McLaughlin • Dislokation • OCT (Athletes) Treatment • Bone Grafting of HH 20-45 % ASK McLaughlin/OCT • (Athlete) • Arthroplastik (low demand) Konservativ >45 % • Arthroplastik • Allograft HH Paul, Beitzel, Imhoff et al., Arthroscopy, 2011

  42. Evidenz (1940 – 2010): Artikel in PubMed: 242 Kleine Case Reports, Reviews etc. 41 Mindestens 4 Patienten eingeschlossen: 11 Paul, Beitzel, Imhoff et al., Arthroscopy, 2011

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