Instability Cases Arthroscopic Rx for 21yr Stabilization now Old - - PowerPoint PPT Presentation

▶
instability cases
SMART_READER_LITE
LIVE PREVIEW

Instability Cases Arthroscopic Rx for 21yr Stabilization now Old - - PowerPoint PPT Presentation

Mar 28, 2023 252 likes •689 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

slide-1
SLIDE 1
slide-2
SLIDE 2

Instability Cases

฀ Rx for 21yr

Old Linebacker with Subluxation and Bony Bankart??

฀ Arthroscopic

Stabilization now

฀ Open Stabilization

now

฀ Nonoperative

Treatment

฀ Stabilization at end

  • f Season
slide-3
SLIDE 3

Case Report

฀ 21 Yr Old All-ACC

Linebacker

฀ Subluxation Episode

mid-season

฀ MRI Bony Bankart ฀ Completes Season

with intermittent symptoms

slide-4
SLIDE 4
slide-5
SLIDE 5
slide-6
SLIDE 6

What Would the Panel Do????

slide-7
SLIDE 7
slide-8
SLIDE 8
slide-9
SLIDE 9
slide-10
SLIDE 10

Posterior Approach For Inferior Anchor

฀ Beach Chair Position ฀ Spider Arm Holder ฀ Anterior Viewing ฀ Posteriolateral

Axillary Portal

฀ 6:00 Inferior “Home-

Run” Anchor

slide-11
SLIDE 11

Instability Collision Athlete

Summary

  • Three Anchors
  • Inferior Anchor

From Posteior Approach

  • Usually 4 total
slide-12
SLIDE 12
slide-13
SLIDE 13

Case #1: Soccer Player

slide-14
SLIDE 14

History

29y, male

  • First consultation 09.01.2017
  • Recurrent ant. inf. dislocations
  • Exacerbation following fall 2012
  • Unknown prior shoulder surgery 2012
slide-15
SLIDE 15

X-Ray 09.01.2017

slide-16
SLIDE 16

MRI 10.01.2017

slide-17
SLIDE 17

Whats wrong?

slide-18
SLIDE 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
slide-19
SLIDE 19

Hospitalisation- X-ray 17.01.2017

slide-20
SLIDE 20

CT 17.01.2017

slide-21
SLIDE 21

CT 17.01.2017

slide-22
SLIDE 22

Treatment options?

slide-23
SLIDE 23
  • Comb. Latarjet and post. bone block

(17.01.2017 / 07.02.2017)

slide-24
SLIDE 24
  • Comb. Latarjet and post. bone block

(17.01.2017 / 07.02.2017)

slide-25
SLIDE 25
  • Comb. Latarjet and post. bone block

(17.01.2017 / 07.02.2017)

slide-26
SLIDE 26
  • Comb. Latarjet and post. bone block

(17.01.2017 / 07.02.2017)

slide-27
SLIDE 27
  • Comb. Latarjet and post. bone block

(17.01.2017 / 07.02.2017)

slide-28
SLIDE 28

CT 09.02.2017

slide-29
SLIDE 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

slide-30
SLIDE 30

CT 26.04.2017

slide-31
SLIDE 31

Computed tomography - 26.04.2017

slide-32
SLIDE 32

Treatment options?

slide-33
SLIDE 33

Surgical procedure – 03.05.2017

  • Glenoid augmentation with iliac crest bone block
  • Secured with two cannulated screws
slide-34
SLIDE 34

Case #2: Ice Hockey Player

slide-35
SLIDE 35

History

40y, male

  • 02/2017 fall during ice skating
  • Reduction by third person
  • Persistent apprehension sign ++
slide-36
SLIDE 36

X-Ray 02/2017

slide-37
SLIDE 37

MRI 02/2017

slide-38
SLIDE 38

Treatment options?

slide-39
SLIDE 39

Modified arthroscopic McLaughlin procedure with bony mosaicplasty

Normal Locked posterior dislocation Reduced Modified McLaughlin with bony mosaicplasty

slide-40
SLIDE 40

6w postop. (04/2017)

slide-41
SLIDE 41

Impression Humerus ? 10-20 % <10 % Posteriore Dislokation Konservativ

  • Konservativ
  • ASK (instabil)

0 % 20-45 % >45 %

  • Konservativ
  • ASK McLaughlin
  • ASK / McLaughlin
  • OCT (Athletes)
  • Bone Grafting of HH
  • ASK McLaughlin/OCT

(Athlete)

  • Arthroplastik

(low demand)

  • Arthroplastik
  • Allograft HH

Paul, Beitzel, Imhoff et al., Arthroscopy, 2011

Strategie

Männlich, 40J

Treatment

slide-42
SLIDE 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