Analysis of Injury Pattern Pathoanatomy and Need for Intervention with Outcome Assessment in Shoulder Dislocation Over the Age of 50 Years

摘要

Aim: Glenohumeral joint, due to its biomechanics and structure, is the most unstable and commonly dislocated joint. Produces double-peak age dispersal, with a second peak in older patients, owing to the recent changes in lifestyle. Elderly dislocations usually present with mosaic injury patterns—rotator cuff tears, disruption of ligamentous structures, labrum Bankart and superior labral anterior to posterior (SLAP), bone (Hill-Sach), fractures, and neurovascular injuries can be a challenge to the treating clinicians. But little has been reported. The goal of this paper is to analyze the epidemiology, pathoanatomy, treatment, and functional outcome in >50 years of the age cohort.Materials and methods: In a prospective study between January 2018 and January 2020,48 patients were enrolled with shoulder dislocation, with 18 of them aged above 50. Analysis was done on injury patterns, radiological characteristics, treatment methods, and functional outcomes using our institutional protocol. Monitored over a period of a minimum of 2 years with Constant-Murley and American Shoulder and Elbow Surgeons (ASES) scores. Results: Around 33.33 of dislocations were in an elderly population, which is quite high than previously reported. Rotator cuff pathology was found in three-fourths of the cohort. A total of 88.89 underwent surgical procedures; among them, 71.42 were involved in cuff repair alone. The solitary incident of biceps tenodesis and repair of the ruptured axillary artery with concomitant open reduction. None had recurrent instability. Constant-Murley and ASES scores improved significantly during the final follow-up.Conclusion: Early diagnosis and ruling out concomitant injuries in anterior shoulder dislocation among >50 years of age and managing them at the earliest has produced good outcomes and warrants a better, complete life in years to come.Clinical significance: Early magnetic resonance imaging (MRI) with computerized tomography (CT) screening helps in diagnosing significant cuff pathology with a portion of labral injury-needing individualized management. Thus, a structured approach is necessary to diagnose and treat this injury pattern which is critical for the recovery and quality of life in this age group.