Objective To investigate the effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation in treatment of recurrent anterior shoulder dislocation combined with massive glenoid bone defects. Methods Between January 2018 and December 2021, 16 male patients with recurrent anterior shoulder dislocation combined with massive glenoid bone defects were treated with arthroscopic autogenous iliac bone grafting and double-row elastic fixation. The patients were 14-29 years old at the time of the first dislocation, with an average age of 18.4 years. The causes of the first dislocation included falling injury in 5 cases and sports injury in 11 cases. The shoulders dislocated 4-15 times, with an average of 8.3 times. The patients were 17-37 years old at the time of admission, with an average age of 25.1 years. There were 5 left shoulders and 11 right shoulders. The preoperative instability severity index (ISIS) score of the shoulder joint was 5.8±2.1, and the Beighton score was 4.3±2.6. The University of California Los Angeles (UCLA) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score were used to evaluate shoulder function, and the degree of the glenoid bone defect repair was observed based on CT after operation. Results All incisions healed by first intention, and no complication such as incision infection or neurovascular injury occurred. The patients were followed up 12 months. At 12 months after operation, UCLA score, Constant score, ASES score, and Rowe score all significantly improved when compared with the scores before operation (P<0.05). CT imaging showed the degree of glenoid bone defect was significantly smaller at immediate, 6 and 12 months after operation when compared with that before operation (P<0.05), and the bone blocks healed with the scapula, and bone fusion had occurred at 12 months. ConclusionArthroscopic autologous iliac bone grafting with double-row elastic fixation is a safe treatment for recurrent anterior shoulder dislocation combined with massive glenoid bone defects, with good short-term effectiveness.
Objective To evaluate the effectiveness of arthroscopic Pushlock anchor fixation with iliac creast bone autograft in the treatment of recurrent anterior shoulder instability with critical bone defect. Methods The clinical data of 80 patients with recurrent anterior shoulder instability with critical bone defect treated by arthroscopic Pushlock anchor fixation with iliac creast bone autograft between January 2016 and January 2019 were retrospectively analyzed. The patients were all male; they were 18-45 years old at the surgery, with an average of 25 years old. The disease duration ranged from 3 months to 5 years, with an average of 2 years. The shoulder joint dislocated 3-50 times, with an average of 8 times. X-ray films, MRI, CT scans and three-dimensional reconstruction of the shoulder were performed before operation. The area of the anterior glenoid defect was 25%-45%, with an average of 27.3%. The shoulder mobility (forward flexion and external rotation in abduction at 90°), the Constant-Murley score, and the Rowe score were used to evaluate the shoulder function before operation and at last follow-up. ResultsPatients were followed up 1-3 years, with an average of 2 years. No shoulder dislocation occurred again during follow-up. All partial graft absorption occurred after operation, CT scan showed that the graft absorption ratio was less than 30% at 1 week and 3 months after operation. CT three-dimensional reconstruction at 1 year after operation showed that all grafts had healed to the glenoid. The anterior glenoid bone defect was less than 5% (from 0 to 5%, with an average of 3.2%). At last follow-up, the shoulder mobility (forward flexion and external rotation in abduction at 90°), the Constant-Murley score, and the Rowe score significantly improved when compared with preoperative ones (P<0.05). The shoulder mobility of external rotation in abduction at 90° of the affected side limited when compared with the healthy side [(6.7±5.1)°]. ConclusionArthroscopic Pushlock anchor fixation with iliac creast bone autograft has a good effectiveness in the treatment of recurrent anterior shoulder instability with critical bone defect. The method is relatively simple and the learning curve is short.
ObjectiveTo investigate the early effectiveness of surgical hip dislocation (SHD) combined with autologous iliac crest bone grafting in the treatment of femoral neck fracture nonunion in adolescents. Methods Between December 2020 and August 2024, 21 adolescent patients with femoral neck fracture nonunion were treated with SHD combined with autogenous iliac bone grafting. There were 16 males and 5 females, aged 15-25 years (mean, 19.1 years). According to the Pauwels classification, there were 8 cases of type Ⅱ fractures and 13 cases of type Ⅲ fractures. After the initial fracture, 18 patients had undergone reduction and internal fixation, while 3 had received conservative treatment. The interval from fracture to the operation was (12.0±9.3) months. Preoperatively, the Harris score was 52.0±4.2, the International Hip Outcome Tool-12 (iHOT-12) score was 45.6±3.2, and the visual analogue scale (VAS) score for pain was 5.1±0.8. Postoperative imaging was reviewed to assess femoral neck fracture healing and whether secondary collapse of the femoral head occurred. The Harris score, iHOT-12 score, VAS score, and complications were evaluated. Results All patients were followed up 12-55 months (mean, 27.7 months). During follow-up, no avascular necrosis of the femoral head, heterotopic ossification, infection, or other complications occurred. At last follow-up, the Harris score, iHOT-12 score, and VAS score were 88.1±4.4, 74.7±5.6, and 1.2±0.6, respectively, all of which significantly improved when compared with preoperative values (P<0.05). In all 21 cases, callus formation was observed at the fracture ends of the femoral neck, with good autogenous bone support and new bone formation in the femoral head and neck, and no collapse of the femoral head was observed. Internal fixator was removed in 5 patients at (25.8±7.1) months postoperatively. ConclusionSHD combined with autologous iliac crest bone grafting has a good early effectiveness in the treatment of femoral neck fracture nonunion in adolescents. The technique not only protects the blood supply of the femoral head, but also fully exposes the structure of the femoral neck fracture, allowing for sufficient freshness, bone grafting, and fixation treatment of the fracture end, thereby achieving good bone healing.