[The initial traumatic shoulder dislocation. Prospective study].

Abstract

The goal of this prospective study was to investigate possible factors which might prevent the recurrence of dislocation after a first time traumatic shoulder dislocation. Of the 504 patients initially recorded, 376 were followed up clinically and radiologically after 1 year, and 324 were followed up after 5 years. 20% (64/324) of the patients examined after 5 years sustained a recurrent dislocation of the shoulder. We can confirm age dependency in the occurrence dislocations (50% of the patients > 30 yrs; 15% > 30 yrs). However, we were unable to find a relationship between the duration of immobilization and the incidence of recurrence redislocation (20% recurrence for 0, 1, 2, 3, > 3 weeks of immobilization). A simultaneous avulsion fracture of the tuberculum majus seems to improve the prognosis for recurrent shoulder dislocation (3/114 = 3%), whereas other bony injuries detected using conventional radiology do not appear to influence the incidence of recurrence. A shoulder stabilisation operation had to be carried out in a total of 10% of the follow-up cases. Based on our experience, we recommend a sufficiently long immobilization period of the freshly injured shoulder. In young patients, extensive and invasive procedures (arthro-MRI, pneumo-arthro-CT, shoulder arthroscopy) should be carried out after the first redislocation.