[Current concepts in treatment of the unstable shoulder. Results of a countrywide survey].
The object of the study was to evaluate the management of patients with acute or recurrent shoulder instabilities. Therefore all trauma, general surgery, and orthopaedic departments in Germany were asked to complete a standardized evaluation form; completed questionnaires were returned from 880 institutions treating shoulder instabilities. Questions were asked about the diagnostic imaging techniques used and about conservative and operative treatment. In addition, the treatment regimens that would be followed for two typical patients were asked for. In patients with shoulder instabilities the following diagnostic imaging techniques were used: X-ray (97.1%), ultrasound (61.3%), CT (29.1%), arthro-CT (26.2%), MRI (13.3%), arthrography (24.1%), and arthroscopy (30.6%). After the first traumatic dislocation the average period of immobilization was 2.2 weeks. Immobilization was achieved with a sling in 2.0%, with a Desault bandage in 38.8%, with a Gilchrist bandage in 72.7%, and with a cast in 4.2% of cases. Open surgical stabilization was performed according to Bankart (30%), Eden-Hybinette (28.6%), Weber (Osteotomy) (27.1%), Lange (15.5%), Putti-Platt (13.6%), and other procedures (Magnusson-Stack, Bristow) only occasionally. The average period of immobilization after open surgery was 3.0 weeks. Arthroscopic stabilization techniques were applied by 7.5%. In a 19-year-old handball player stabilization would be performed immediately after the first traumatic dislocation in 9.2% of the institutions; in 34.4% the patient would not be operated on, and in 56.3% the shoulder would be stabilized after the third redislocation.(ABSTRACT TRUNCATED AT 250 WORDS)
Jerosch
J
J
Klink und Poliklinik für Allgemeine Orthopädie, Westfälischen Wilhelms-Universität Münster.
Drescher
H
H
Steinbeck
J
J
Lewejohann
B
B
D000328:Adult; D001182:Arthroscopy; D001265:Athletic Injuries / Q000175:diagnosis / Q000601:surgery; D001291:Attitude of Health Personnel; D003952:Diagnostic Imaging; D005260:Female; D005858:Germany; D006801:Humans; D007103:Immobilization; D007593:Joint Instability / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012783:Shoulder Dislocation / Q000175:diagnosis / Q000601:surgery*
Aktuelle Konzepte bei der Behandlung der instabilen Schulter. Ergebnisse einer bundesweiten Befragung.