Check-Rein Technique for Management of Neglected Locked Posterior Shoulder Dislocations: Evaluation of Mid-term Outcome of a Novel Technique

Introduction: Neglected locked posterior shoulder dislocations, although rare, are quiet perplexing to manage. Various treatment methods have been explained for their management, but a consensus is still lacking. Besides describing a novel technique for the management of these lesions, this study aims to evaluate the mid-term outcome of this technique. Method: This prospective study involved seven consecutive patients with locked posterior dislocation of the shoulder with humeral defect between 25% and 50%. All patients underwent open reduction of the locked posterior dislocation with the current technique. The final outcome was assessed at a mean follow up of 3.5 years (range 2-5 years) using the DASH score. Result: The mean age of the patients was 32 years (range 21- 44) and all were men. The mean time to presentation from initial injury was 2.4 years (range 2-4 years). The patient related outcome as measured by DASH score improved from a preoperative mean of 59.1 to mean value of 8.6 at the time of final follow up. There were no cases of graft pull out, nonunion at the graft site or infection. Conclusion: This technique results in pain-free range of motion with a stable shoulder though a larger sample population with a longer follow up is required to further support our observations

Modified Pauwels’ Intertrochanteric Osteotomy in Neglected Femoral Neck Fracture

Many reported treatment methods for neglected femoral neck fractures do not always satisfactorily address nonunion, coxa vara, and limb shortening. We retrospectively reviewed the functional outcome of the modified Pauwels’ intertrochanteric osteotomy in 48 adults (mean age, 48.1 years) to determine whether this approach would correct those problems. The average preoperative limb shortening was 2.7 cm (range, 1.5–5 cm) in 38 patients and mean neck-shaft angle was 107.3° (range, 80°–120°). The minimum followup was 2 years (mean, 6.1 years; range, 2–16.5 years). Union was achieved in 44 of the 48 patients. Union also was achieved in two of the four nonunions after revision osteotomy. Postoperative avascular necrosis of the femoral head developed in two of the 48 patients after an average followup of 6 years. Limb-length equalization was achieved in 40 (83%) patients and 40 had near-normal gait. The average neck-shaft angle at the final followup was 132.7° (range, 120°–155°). The average Harris hip score was 86.7 points and Merle d’Aubigné-Postel score was 14.1. We believe the primary modified Pauwels’ intertrochanteric osteotomy is a reliable alternative to achieve fracture healing in neglected femoral neck fractures and simultaneously correct associated coxa vara and shortening. A two-stage surgical incision makes the procedure simple and less demanding