title: Latarjet Procedure for Anterior Shoulder Instability Due to Tramadol-Induced Seizures: A Multicenter Study.
abstract: BACKGROUND
  Seizures, commonly due to epilepsy, are known to cause shoulder instability. Tramadol addiction has recently been found to induce seizures in patients who exceed the recommended dose. Because of the easy accessibility and low cost of tramadol, an increasingly alarming phenomenon of tramadol abuse has been demonstrated in recent years.
  
  
  OBJECTIVE
  The purpose of this multicenter study was to investigate shoulder instability resulting from tramadol-induced seizure (TIS) as well as to recommended management for such shoulder instability. The hypothesis was that TIS leads to anterior shoulder dislocations with major bony defects, which favors bony reconstructive procedures as a suitable method of treatment.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  This prospective case series study was conducted on 73 patients (78 shoulders) who presented with anterior shoulder dislocations and a clear history of tramadol abuse. The mean age of the patients was 26.8 years, and the mean number of dislocations was 14. The mean duration of addiction was 17 months, with a mean dose of 752 mg of tramadol hydrochloride per day. Glenoid and humeral bone loss ranged from 15% to 35% and from 15% to 40%, respectively. The mean follow-up period was 28 months. All patients underwent an open Latarjet procedure.
  
  
  RESULTS
  Postoperative mean Rowe score and American Shoulder and Elbow Surgeons score at final follow-up (24 months) improved significantly from 20 to 84 and from 44 to 91, respectively (P < .05). The patient satisfaction rate reached 95%, and the mean period of return to work was 12.8 weeks. Five patients (9%) had postoperative seizures due to relapse of the tramadol abuse, but only 3 patients (5%) had redislocations with nonunion or breakage of the graft or hardware.
  
  
  CONCLUSIONS
  Tramadol addiction has evolved as an important cause of seizures that can result in shoulder dislocation. Anterior shoulder instability with TIS occurs mainly with higher levels of addiction and results in significant humeral and/or glenoid bone defects. The Latarjet procedure is recommended for these patients, after control of addiction, and provides 95% satisfaction at midterm follow-up.
authors.affiliation: Orthopaedic Department, Ain Shams University, Cairo, Egypt.
authors.forename: Ahmad Hany
authors.initials: AH
authors.lastname: Khater
authors.affiliation: Orthopaedic Department, Ain Shams University, Cairo, Egypt.
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Sobhy
authors.affiliation: Orthopaedic Department, Assiut University, Assiut, Egypt hatemgalal@yahoo.com.
authors.forename: Hatem G
authors.initials: HG
authors.lastname: Said
authors.affiliation: Orthopaedic Department, Alexandria University, Alexandria, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Kandil
authors.affiliation: Orthopaedic Department, Cairo University, Cairo, Egypt.
authors.forename: Walid
authors.initials: W
authors.lastname: Reda
authors.affiliation: Orthopaedic Department, Cairo University, Cairo, Egypt.
authors.forename: Ahmed Fouad
authors.initials: AF
authors.lastname: Seifeldin
authors.affiliation: Neurology Department, Ain Shams University, Cairo, Egypt.
authors.forename: Ramez
authors.initials: R
authors.lastname: Moustafa
authors.affiliation: Orthopaedic Department, Assiut University, Assiut, Egypt.
authors.forename: Maher A
authors.initials: MA
authors.lastname: Elassal
authors.affiliation: Orthopaedic Department, Ain Shams University, Cairo, Egypt.
authors.forename: Ezzat M
authors.initials: EM
authors.lastname: Kamel
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000209:etiology / Q000601:surgery*; D008297:Male; D009293:Opioid-Related Disorders / Q000150:complications; D019637:Orthopedic Procedures / Q000379:methods*; D017060:Patient Satisfaction; D011446:Prospective Studies; D012640:Seizures / Q000139:chemically induced / Q000150:complications*; D012783:Shoulder Dislocation / Q000209:etiology / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery; D014147:Tramadol / Q000009:adverse effects*
chemical_list: D000701:Analgesics, Opioid; D014147:Tramadol
keywords: Latarjet; TIS; anterior shoulder instability; recurrent anterior shoulder dislocations; seizures; tramadol