Correlation of Antero-inferior Glenoid Bone Loss with Number of Dislocations and Mode of Injury Aravindh Palaniswamy, MS 1 , Hira Lal Nag, MS 1 , Dhanasekaraprabu, MS 1 , Deep N Srivastava, MD 2 Department of Orthopaedics 1 & Radiodiagnosis 2 , All India Institute of Medical Sciences, New Delhi, India
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Correlation of Antero Inferior Glenoid Bone Loss with Number of Dislocations and Mode of Injury-Dr. Aravindh Palaniswamy
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Correlation of Antero-inferior Glenoid Bone Loss with Number of Dislocations and Mode
of Injury
Aravindh Palaniswamy, MS1 , Hira Lal Nag, MS1 , Dhanasekaraprabu, MS1 , Deep N Srivastava, MD2
Department of Orthopaedics1 & Radiodiagnosis2,All India Institute of Medical Sciences, New Delhi, India
Introduction
• Recurrent shoulder dislocation is a common cause of
morbidity among young adults with an annual incidence of
0.084% & 1.7%(1) .
• Natural history of the unstable shoulder evolves towards
progressive glenoid bone loss.
• Incidence as high as 86%(2) in recurrent instability.
1.Hovelius L. Incidence of shoulder dislocation in Sweden. Clin Orthop Relat Res 982:127-131.2.Griffith JF, Antonio GE, Yung PSH, Wong EMC, Yu AB, Ahuja AT, et al. Prevalence, Pattern, and Spectrum of Glenoid Bone Loss in Anterior Shoulder Dislocation: CT Analysis of 218 Patients. Am. J. Roentgenol. 2008 May;190(5):1247–54.
Introduction
• The integrity of the osseous architecture of the glenoid has
been highlighted as one of the most important factors related
to the success/failure of surgical repair(3,4).
3.Randelli P, Ragone V, Carminati S, Cabitza P. Risk factors for recurrence after Bankart repair a systematic review. Knee Surg. Sports Traumatol.Arthrosc. 2012 Jul 27;20(11):2129–38. 4.ITOI E, LEE S-B, BERGLUND LJ, BERGE LL, AN K-N. The Effect of a Glenoid Defect on Anteroinferior Stability of the Shoulder After Bankart Repair: A Cadaveric Study*. J. Bone Jt. Surg. 2000;82(1):35–46.
6.MOON Shoulder Group, Bishop JY, Jones GL, Rerko MA, Donaldson C. 3-D CT is theMost Reliable Imaging Modality When Quantifying Glenoid Bone Loss. Clin.Orthop.Relat. Res. 2012 Sep 21;471(4):1251–6.
Introduction
• Glenoid bone loss – multifactorial origin(5)
– Increasing number of dislocations
– Trauma at first dislocation
– Age of first dislocation
• Considered as strong predictors for the presence and the
percentage of glenoid bone defect
5.Provencher CMT. Recurrent Shoulder Instability: Current Concepts for Evaluation andManagement of Glenoid Bone Loss. J. Bone Jt. Surg. Am. 2010 Dec 1;92(Supplement_2):133.
Study Rationale – Pre-Op CT ?
• Is it Specific findings in the history and the physical
examination provide important clues to the presence of
glenoid bone loss.
• Is it critical to evaluate all patients with recurrent shoulder
instability for the presence of osseous injuries to the glenoid.
Objectives
• To correlate the percentage of glenoid bone loss with ‘number
of dislocations’.
• To asses the influence of ‘mode of injury’ on glenoid bone loss
in patients with recurrent anterior dislocation of shoulder.
Methodology
• Type of study
– Observational Study
• Sample size
– 20 patients
• Approved by Institutional ethics committee
• Informed consent obtained
Methodology
Inclusion criteria
• Patients with recurrent
anterior shoulder
dislocation
• Unilateral involvement
• Age 15 to 45 years
Exclusion criteria
• Habitual dislocation
• H/o previous surgery for
shoulder dislocation
• Any associated congenital
anomaly
Patient Evaluation
• A detailed clinical history
– Mode of injury (Trauma/Sports Injury) which led to dislocation
– Frequency of dislocations were noted
• Physical examination for anterior apprehension & s/o
laxity
Patient Evaluation
• CT Protocol & Image Analysis
– Simultaneous CT examination of both shoulders were
acquired in MDCT scanners (Somatom sensation, Siemens,
Erlanger, Germany) with a volume data acquisition of 0.6 X
40, slice thickness of 0.6 mm with the scanning plane
extending from the acromion to just below glenoid.
Patient Evaluation
– 3D volume rendered
images were
reconstructed
– ‘En face view of
glenoid’ obtained
after subtracting
humeral head.
Patient Evaluation
• Calculation of glenoid index
– On en face view of glenoid of 3 D volume rendered image with use of built in software tools of Siemens Syngo.
– A line drawn along the long axis of glenoid & second glenoid line drawn perpendicular to the long axis of glenoid at the inferior glenoid from the posterior margin to the anterior margin
Patient Evaluation
• Calculation of glenoid bone loss
– Width of the glenoid (glenoid index) in millimetres
calculated on affected(d) and normal shoulder(D)
– Based on the glenoid linear defect method percentage of
bone loss was calculated using the formula
[ (D-d)/D] x 100
• Statistical analysis performed with statistical software (SPSS
version 19)
Results
• Mean age 26.5 ±5.9 years (range 20 to 42 years)
• Male: Female ratio 19:1
• 70% of patients (n=14) had dislocation of right shoulder
• Glenoid bone loss present in 90% (n=18) patients
• 10 patients had ≤ 10% glenoid bone loss, 5 patients between 10 and 20%, 2 between 20 and 30% while 1 patient had >30% bone loss
• Sports injury was the predominant mode of injury in 55% of patients (n=11) while trauma was implicated in rest of the patients
• No. of recurrent dislocations varied from 2 to 20 with a mean of 7.7 (± 5.7)
No. of dislocations and glenoid bone loss (%) in individual study patients