Name of the Procedure:

Open treatment of shoulder dislocation, with surgical or anatomical neck fracture, includes internal fixation, when performed

Summary

This procedure involves surgically repositioning a dislocated shoulder, which is complicated by a fracture in the anatomical or surgical neck of the humerus. Internal fixation is used to stabilize the fracture.

Purpose

This procedure aims to correct a shoulder dislocation and simultaneously repair a fractured neck of the humerus. The primary goal is to restore proper shoulder function and alleviate pain by ensuring the bones and joint heal in the correct alignment.

Indications

• Severe shoulder dislocation with an associated fracture of the surgical or anatomical neck of the humerus
• Inability to maintain shoulder stability through non-surgical methods
• Persistent pain and restricted shoulder movement
• Patients with high physical activity demands or occupations requiring optimal shoulder function

Preparation

• Patients are usually required to fast for several hours before surgery.
• Medication adjustments may be necessary, especially blood thinners.
• Preoperative imaging (X-rays, MRI) and physical assessments are conducted.
• Anesthesia evaluation to determine the suitable type of anesthesia.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A surgical incision is made near the shoulder joint.
3. Reduction: The dislocated shoulder is put back into its correct position.
4. Fracture Fixation: The fractured bones are aligned, and internal fixation devices such as screws, plates, or rods are used to stabilize the fracture.
5. Closure: The incision is closed with sutures or staples, and a sterile dressing is applied.
6. Postoperative Care: The shoulder is often immobilized in a sling or brace to ensure proper healing.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity of the fracture and dislocation.

Setting

The procedure is performed in a hospital operating room or a surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist
• Surgical technicians

Risks and Complications

• Infection at the surgical site
• Blood clots
• Nerve or blood vessel damage
• Prolonged pain or stiffness
• Hardware complications, requiring further surgery

Benefits

• Restoration of shoulder stability and function
• Pain relief
• Improved range of motion
• Prevention of future dislocations

These benefits are typically realized within a few weeks to months, depending on the individual’s healing response.

Recovery

• Postoperative pain management with medications
• Physical therapy to regain strength and mobility
• Sling or brace usage for several weeks
• Follow-up appointments to monitor healing
• Gradual return to normal activities within 3 to 6 months

Alternatives

• Closed reduction without surgery: Repositioning the shoulder without open surgery; suitable for less severe cases.
• Non-surgical immobilization: Using a sling or brace to allow natural healing; may suffice for minor fractures.
• Arthroscopic surgery: A less invasive option using small incisions and a camera; limited to specific types of injuries.

Pros of the open treatment include more secure fixation of the fracture and reduced risk of recurrent dislocation. However, it involves a longer recovery time and higher risk of surgical complications.

Patient Experience

During the procedure, patients are under general anesthesia and will not experience pain or sensations. Post-surgery, there will be some pain and discomfort managed through medications. The shoulder may feel stiff and weak initially, but pain should decrease as healing progresses. Physical therapy is crucial for optimal recovery and regaining strength and function.