A 5-year evaluation and results of treatment of chronic locked dislocations of the shoulder joint

Background: Chronic neglected dislocation of the shoulder joint can be defined as a neglected dislocation for more than a 3 week period. However, it has been shown that the negligence could range from a 24 hour period to 6 months1. Depending on age, signs, symptoms, etiology and types of dislocation, conservative treatment or surgical intervention could be considered. Methods: In this study, 16 patients (13 were male and 3 were female) were treated with chronic shoulder dislocations, 3 of which had bilateral dislocations. The age of this group ranged from 13-65 years with a mean age of 34 years. These patients were treated by closed or open reduction, either anterior, posterior or both approaches. Of 19 dislocations, 6 were anterior unilateral, 7 posterior unilateral, 1 anterior bilateral and 2 posterior bilateral dislocations. The mean period between dislocations and treatments was 3 months (from 4 weeks to 11 months), and the mean follow up period was 40 months (from 21 months to 5 years). Results: This study has shown that treatment varies according to pathology. In this study the mean size of head defects was 35% and the extent of severity determined the approach. Findings at the last follow up were assessed according to Rowe and Zarins score and of the 19 shoulders assessed, 9 showed good and 10 showed excellent results. There was no recurrence of the dislocation in any patient. Conclusion: In some selected instances, open reduction of a chronic locked neglected shoulder dislocation of a 6 months period or more in young patients is recommended. This method is, however, contraindicated in elderly patients; in such cases a shoulder prosthesis is indicated.