Details
Category: Volume 06 Issue 05 May 2018
Hits: 1524

Title: Outcome of Latarjet Technique with low Profile Single 4.0 MM Titanium Screw and Washer for Recurrent Dislocation of Shoulder: A Prospective Study

Authors: Dr Girish Shinde, Dr Satishkumar A Patil, Dr Nagesh Naik, Dr Amit Jagdale

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.22

Abstract

Shoulder joint is one of the commonest joint to dislocate and account for majority of all the dislocations seen in the orthopaedic emergency department. Shoulder joint is prone for dislocations because of a shallow glenoid that articulates only with a small part of the humeral head. Recurrent dislocation of shoulder is also a common occurrence after first episode of dislocation and is seen more commonly in young patients having rotator cuff injuries or fracture of glenoid during initial dislocation. Management of recurrent dislocation is essentially surgical. Latarjet technique, first described by Latarjet M in 1954, is found to have excellent outcome in cases of recurrent shoulder dislocation. It consists of removal and transfer of a section of the coracoid process and its attached muscles to the front of the glenoid. The definitive graft fixation may be achieved using cortical screws and washers. We conducted this prospective study to analyze the outcome of patients having recurrent dislocation of shoulder treated by Latarjet technique using single 4.0mm titanium screw and washer.

Aims and Objectives: To study clinical outcome and complications in patients with recurrent shoulder dislocation managed with Latarjet-Bristow procedure using single 4.0 mm titanium screw and washer.

Materials and Methods: The study was carried out in department of orthopaedics in a teaching institute situated in an urban area. All patients admitted for recurrent shoulder dislocation and managed with Latarjet-Bristow procedure using single 4.0 mm titanium screw and washer were included in this study depending upon inclusion criteria. Any patient having any exclusion criteria was excluded from the study. Type of shoulder dislocation was diagnosed on the basis of imaging. X-Ray shoulder (AP view, internal rotation, external rotation and neutral position) was done in all the cases. 3 D CT of shoulder joint and MRI were done in selected cases. All patients underwent Latarjet-Bristow procedure and graft fixation was achieved using single 4.0mm titanium screw and washer. The outcome of patients was studied by analysing pre-operative and post operative Walch-Duplay and ROWE score scores. 

Results: Out of 30 cases there were 22 (73.33 %)  Males and 8 (26.66 %) females with a M: F ratio of 1: 0.36. The most common affected age group was found to be between 26-35 years (40%) followed by 18-25 years (33.33%) and 36-40 years (20%) and most common mechanism of injury during first episode of shoulder dislocation was found to be fall (43.33%) followed by motor vehicular accidents (40 %) and sports injury (16.66 %). In 19 (63.33 %) patients shoulder dislocation was seen on right side and in 11 (36.66 %) patients the dislocation was seen on left side. Postoperatively 27 (90%) and 26 (86.66%) patients had either excellent or good outcome on the basis of Walch-Duplay Scores and ROWE score respectively. Post operative complications were seen in 4 (13.33%) patients and included hematoma, wound infections and nerve injury (neuropraxia) which resolved within 6 weeks. 

Conclusion: In patients with recurrent shoulder dislocation Latarjet-Bristow technique using 4.0-mm titanium screw and washer for graft fixation is an excellent procedure with satisfactory outcome and low complication rates. 

Keywords: Recurrent Shoulder Dislocation, Latarjet technique, Complications, Outcome.

References

  1. Cutts S, Prempeh M, Drew S. Anterior Shoulder Dislocation. Annals of The Royal College of Surgeons of England. 2009;91(1):2-7. 
  2. Atef A, El-Tantawy A, Gad H, Hefeda M. Prevalence of associated injuries after anterior shoulder dislocation: a prospective study. Int Orthop. 2016 Mar;40(3):519-24.
  3. Itoi E. Rotator cuff tear: physical examination and conservative treatment. Journal of Orthopaedic Science. 2013;18(2):197-204. 
  4. Bahr R, Craig EV, Engebretsen L. The clinical presentation of shoulder instability including on field management. Clin Sports Med. 1995 Oct;14(4):761-76.
  5. Ruiz Santiago F, Martínez Martínez A, Tomás Muñoz P, Pozo Sánchez J, Zarza Pérez A. Imaging of shoulder instability. Quantitative Imaging in Medicine and Surgery. 2017;7(4):422-433. 
  6. Srinivasan S, Pandey R. Current Concepts in the Management of Shoulder Instability. Indian Journal of Orthopaedics. 2017;51(5):524-528. 
  7. Saccomanno Mf, Fodale M, Capasso L, Cazzato G, Milano G. Generalized joint laxity and multidirectional instability of the shoulder. Joints. 2013;1(4):171-179.
  8. LATARJET M. [Treatment of recurrent dislocation of the shoulder]. Lyon Chir. 1954 Nov-Dec;49(8):994-7.
  9. Doursounian L, Debet-Mejean A, Chetboun A, Nourissat G. Bristow-Latarjet procedure with specific instrumentation: study of 34 cases. International Orthopaedics. 2009;33(4):1031-1036. 
  10. Elkousy H, Gartsman GM, Labriola J, O'Connor DP, Edwards TB. Subscapularis function following the latarjet coracoid transfer for recurrent anterior shoulder instability. Orthopedics. 2010 Nov 2;33(11):802.
  11. Razmjou H, Lincoln S, Macritchie I, Richards RR, Medeiros D, Elmaraghy A. Sex and gender disparity in pathology, disability, referral pattern, and wait time for surgery in workers with shoulder injury. BMC Musculoskeletal Disorders. 2016;17:401. 
  12. Gopalakrishnan S. A Public Health Perspective of Road Traffic Accidents. Journal of Family Medicine and Primary Care. 2012;1(2):144-150.
  13. Shah A, Judge A, Delmestri A, et al Incidence of shoulder dislocations in the UK, 1995–2015: a population-based cohort study BMJ pen 2017;7:e016112.
  14. Da Silva LA, da Costa Lima ÁG, Kautsky RM, Santos PD, do Val Sella G, Checchia SL. Evaluation of the results and complications of the Latarjet procedure for recurrent anterior dislocation of the shoulder. Revista Brasileira de Ortopedia. 2015;50(6):652-659. 
  15. Fontanesi G, Mele C, Ferrari A, Fusaro I. Anterior recurrent dislocation of shoulder treated by the Latarjet technique: our experience. Chir Organi Mov. 1996 Jan-Mar;81(1):1-9.
  16. Matton D, Van Looy F, Geens S. Recurrent anterior dislocations of the shoulder joint treated by the Bristow-Latarjet procedure. Historical review, operative technique and results. Acta Orthop Belg. 1992;58(1):16-22.
  17. Chaudhary D, Goyal A, Joshi D, Jain V, Mohindra M, Mehta N. Clinical and radiological outcome after mini-open Latarjet technique with fixation of coracoid with Arthrex wedge mini-plate. J Clin Orthop Trauma. 2016 Jan-Mar;7(1):23-9.
  18. Raiss P, Lin A, Mizuno N, Melis B, Walch G. Results of the Latarjet procedure  for recurrent anterior dislocation of the shoulder in patients with epilepsy. J Bone Joint Surg Br. 2012 Sep;94(9):1260-4.
  19. Bliven KCH, Parr GP. Outcomes of the Latarjet Procedure Compared With Bankart  Repair for Recurrent Traumatic Anterior Shoulder Instability. J Athl Train. 2018  Feb;53(2):181-183.
  20. Shah AA, Butler RB, Romanowski J, Goel D, Karadagli D, Warner JJ. Short term complications of the Latarjet procedure. J Bone Joint Surg Am. 2012 Mar 21;94(6):495-501.

Corresponding Author

Dr Satishkumar A Patil

Junior Consultant, PIOS Multispeciality Hospital Jaysingpur- Maharashtra- India