A case report of ten-month-neglected anterior shoulder dislocation managed by open reduction combined with Latarjet procedure

Abstract

Introduction: Neglected shoulder dislocation is a rare case and may be accompanied by pathological changes in bony and soft tissue structure. Therefore, it requires extensive surgical procedure. Until now, there is no standard treatment protocol to overcome this case and it is still a challenging case.

Presentation of case: We presented a 27-year-old male patient with deformity on his left shoulder. The patient has suffered a ten-month-neglected anterior shoulder dislocation with a Hill-Sachs lesion. The treatment was open reduction combined with Latarjet procedure. Evaluation of treatment was performed three months after surgery.

Discussion: Management of a neglected shoulder dislocation, especially with significant bony defects, is challenging and cannot be managed with standard surgical technique because of severe soft-tissue contracture and imbalance as well as bone deficiency. Chronic locked anterior shoulder dislocation is a difficult condition for both patient and clinician. In addition to that, the treatment results can be unsatisfactory. Latarjet procedure has been shown to be effective for the treatment of recurrent anterior shoulder dislocation with a large glenoid osseous defect which might justify the application of this procedure for the treatment of neglected anterior shoulder dislocation.

Conclusion: Open reduction combined with Latarjet procedure performed for treatment of neglected anterior shoulder dislocation was found to have a high rate of successful in preventing further dislocation of the shoulder joint although the high risk of osteoarthritis of the shoulder joint can still persist.

Keywords: Case report; Latarjet procedure; Neglected shoulder dislocation; Open reduction.

Fig. 1

(a) Clinical picture of bilateral shoulder showing a squaring left shoulder with muscle atrophy. (b) X-ray antero-posterior view of the left shoulder showing anterior dislocation of glenohumeral joint. (c) CT scan showed a Hill-Sachs lesion on the humeral head (pointed by arrow).

Fig. 2

Massive fibrotic tissue around humeral head (pointed by arrow).

Fig. 3

(a) Latarjet procedure: osteotomized coracoid process has been attached to antero-posterior part of the glenoid rim (pointed by arrow). (b) Post-operative X-ray antero-posterior view of the left shoulder showing a reduce glenohumeral joint with fixation of Kirschner wire and 2 screws, in accordance with Latarjet procedure.

Fig. 4

Three months post-operative X-ray antero-posterior view of the left shoulder showing loss of the humeral head contour.