Fractures of the proximal humerus constitute approximately 5% of all fractures. Shoulder joint injuries without any external mechanical impact during seizures with the occurrence of spasms occur only sporadically. The occurrence rate is reported in approximately 0.4% of patients. Very rarely they occur in the form of epileptic seizure-induced dorsal fracturedislocation impacting both sides. The case report describes a case of a 48-year-old woman with no treatment for epileptic seizures in her medical history. During the first seizure she sustained a bilateral dorsal fracture-dislocation caused by a muscle spasm, without any other mechanical impact. The fractures were classified as a 3-fragment fracture on the right side and a 4-fragment fracture on the left side. After the patient's admission to the inpatient emergency department, reduction under anaesthesia was attempted. Subsequently, after preparation, open reduction and osteosynthesis using an angularly stable plate were performed as a two-stage surgery. No complications were observed postoperatively Currently, at 3 years after surgeries, the female patient has full mobility of her shoulder joints with no subjective difficulties. Key words: epilepsy, seizure, dorsal fracture-dislocation of the proximal humerus.

• MeSH
• dislokovaná fraktura chirurgie   MeSH
• epilepsie etiologie   MeSH
• fraktury proximálního humeru * chirurgie   komplikace   MeSH
• lidé středního věku MeSH
• lidé MeSH
• luxace ramenního kloubu chirurgie   etiologie   MeSH
• vnitřní fixace fraktury metody   MeSH
• záchvaty etiologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• artroskopie metody   MeSH
• bolest ramene diagnóza   etiologie   MeSH
• burzitida chirurgie   diagnóza   farmakoterapie   MeSH
• diferenciální diagnóza MeSH
• luxace ramenního kloubu chirurgie   diagnóza   etiologie   MeSH
• pooperační péče metody   rehabilitace   MeSH
• poranění ramene chirurgie   etiologie   MeSH
• poranění rotátorové manžety chirurgie   diagnóza   MeSH
• ramenní kloub * chirurgie   patofyziologie   MeSH
• syndrom zhmožděného ramene chirurgie   diagnóza   farmakoterapie   MeSH
• techniky fyzikální terapie * MeSH
• věkové faktory MeSH
• Publikační typ
• přehledy MeSH

Glenohumeral joint is the most frequently dislocated joint of the human body. Concomitant fractures of the coracoid process and tuberculum majus in humeral dislocation of the shoulder joint are rarely described. Concomitant fractures are results of a significant contraction of the surrounding muscles and rotator cuff during a cerebral paroxysm. Due to the small number of cases, the treatment of such injuries is not simple and it is based on an algorithm for treatment of isolated injuries of these anatomical structures. In this case report, we describe a concomitant fracture of the coracoid process and tuberculum majus during an anterior shoulder dislocation in 25-year-old patient after an epileptic seizure. The injury was treated in our department surgically, with a good functional result. The absolute Constant score for the operated arm is 95 points, the relative Constant score is 97%, DASH score 0, VAS score 0.

• MeSH
• dospělí MeSH
• fraktury kostí * komplikace   MeSH
• humerus MeSH
• lidé MeSH
• luxace ramenního kloubu * komplikace   chirurgie   MeSH
• processus coracoideus MeSH
• ramenní kloub * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

PURPOSE OF THE STUDY Acromioclavicular (AC) joint dislocation and its surgical treatment still raises a number of questions that remain to be answered. In some types of dislocations, Rockwood type III in particular, the indication for surgical treatment as such is relative. There are numerous techniques and implants available for the reconstruction of AC joint. In our research we focused on the necessity of coracoclavicular (CC) joint reconstruction. MATERIAL AND METHODS In this paper, a cohort of 56 patients with Rockwood type III AC joint injury who underwent surgical treatment at our department in 2010-2016 period was retrospectively evaluated. The patients were treated with open reduction with AC joint stabilisation using hook plate or tension band. The patients were divided into 2 groups, namely group 1 with CC ligament reconstruction and group 2 without CC ligament reconstruction. The assessment was done at 6 months, 1 year and 2 years after surgery. The clinical outcomes were assessed based on the absolute Constant score (CS) and coracoclavicular distance (CCD) on the X-ray. Subsequently, the outcomes were statistically processed and compared using the Student s ttest. RESULTS The least invasive surgical intervention, as to the length of incision, was the reconstruction using the hook plate without CC ligament suture, whereas the longest incision was performed in tension band with CC ligament suture. In the CC ligament suture group, the mean operative time was 10 minutes longer. When evaluating the CS of the compared groups with and without CC ligament reconstruction, no statistically significant difference (p > 0.05) was found between the two groups. Similarly, the CCD values at 2-year follow-up did not show any statistically significant difference between the two groups (p > 0.05). CONCLUSIONS The available outcomes suggest that the surgical methods used by us are adequately safe and reliable. Good clinical outcomes can be achieved by open reduction and fixation of Rockwood type III AC joint dislocation even without CC ligament reconstruction. Key words: acromioclavicular dislocation, classification, reconstruction, coracoclavicular ligament.

• MeSH
• dislokace kloubu * chirurgie   MeSH
• kloubní ligamenta chirurgie   MeSH
• lidé MeSH
• luxace ramenního kloubu * chirurgie   MeSH
• retrospektivní studie MeSH
• sutura MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

PURPOSE OF THE STUDY This study aimed to evaluate the clinical outcomes and the rate of recurrence in patients who had undergone arthroscopic Bankart repair with remplissage for anterior instability of the glenohumeral joint. MATERIAL AND METHODS The study included 96 arthroscopic Bankart procedures with remplissage performed between 2013 and 2019 at our department in 93 patients (81 men and 12 women; with the mean age of 33 years). We gathered and analysed preoperative data, including a 3D-CT scan of the affected shoulder. Apart from stability, the functional results were assessed postoperatively using the WOSI, SSV, Rowe score, and by measuring the strength of shoulder girdle muscles. The non-parametric MannWhitney U-test was used to identify the predisposing factors for recurrence of glenohumeral instability. RESULTS The arthroscopic Bankart repair with remplissage was indicated in 74 shoulders for primary TUBS and in 22 shoulders as a revision procedure. The recurrent instability was observed in 13 of 96 operated shoulders (13.5%). Subjective instability (positive apprehension test in the extreme positions of the shoulder joint, in abduction and external rotation in particular) was reported by 10 patients (10/13; 77%), three patients experienced a redislocation of the glenohumeral joint in the postoperative follow-up (3/13 patients; 23%). The risk of recurrence of the glenohumeral instability was not correlated with either the number of previous stabilisation procedures, or any other preoperative or intraoperative parameters. Conversely, a new postoperative injury was a factor of key importance. The patients with recurrent instability (subjective instability or glenohumeral dislocation) achieved a significantly lower Rowe score, SSV, postoperative VAS, and worse overall satisfaction with the procedure compared to the group with no recurrent instability. The remplissage induced minor limitations of external rotation at 0° abduction and internal rotation at 90° abduction. After rehabilitation, the muscle strength of the operated shoulder in both groups was comparable to that of the untreated shoulder in all planes of the shoulder range of motion. DISCUSSION Our study confirms the clinical relevance of the addition of remplissage to the arthroscopic Bankart procedure for reducing the rate of recurrent glenohumeral instability in TUBS with a clinically significant Hill-Sachs lesion. Satisfaction with the surgical outcome is high; the functional outcomes are very good, including muscle strength. Surprisingly, though, the risk of recurrent instability does not correlate with the number of implants used in the stabilisation procedure. CONCLUSIONS Addition of remplissage to the arthroscopic Bankart stabilisation in patients with a clinically significant Hill-Sachs lesion shows a low risk of recurrence of glenohumeral instability after surgery compared to the conventional arthroscopic Bankart repair alone. The remplissage does cause minor restrictions in the glenohumeral joint external rotation, but it was not reflected in the satisfaction of patients or a lower clinical score of the shoulder joint. The preoperative assessment of the HillSachs lesion using the "glenoid track" on a 3D-CT scan helps improve the preoperative planning and prediction of outcomes of the stabilisation procedure. Key words: glenohumeral instability, Bankart defect, Hill-Sachs lesion, Bankart repair, remplissage, arthroscopy.

• MeSH
• artroskopie metody   MeSH
• Bankartova léze * chirurgie   MeSH
• dospělí MeSH
• lidé MeSH
• luxace ramenního kloubu * chirurgie   MeSH
• nestabilita kloubu * etiologie   chirurgie   MeSH
• ramenní kloub * diagnostické zobrazování   chirurgie   MeSH
• rameno MeSH
• recidiva MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

PURPOSE OF THE STUDY The purpose of this study is to remind of the specific features of diagnosis and therapy of dorsal dislocations of the glenohumeral joint to prevent frequent neglect or misdiagnosis during primary treatment. Also, we strived to present our experience and outcomes of posterior dislocation treatment by McLaughlin procedure and its modified version. MATERIAL AND METHODS We retrospectively evaluated 7 patients who had been treated at our department in the period 2015-2019 by McLaughlin procedure or its modification. The group consisted of 5 men and 2 women aged 33-79 years. In five patients, the dislocation occurred during an epileptic seizure, in two patients during an accident. The patients were treated by McLaughlin procedure or the Neer modification of McLaughlin procedure. The deltoideopectoral surgical approach was always used. Based on the preoperative planning, we decided, or intraoperatively changed our decision, as to whether mere transposition of the subscapularis is satisfactory or whether transposition of the lesser tuberosity to the defect, a bone graft and arthroplasty are necessary. Postoperatively, the operated limb was fixed for 6 weeks in neutral position, which was followed by rehabilitation. RESULTS We evaluated subjective and objective outcomes of the surgery, the radiological finding and in 2 patients also a control CT scan. The function of the shoulder was assessed using the Constant shoulder score and the OSIS scoring system. The resulting score: the mean OSIS was 55.7 points (92.8%) and the mean Constant score was 86.2 points (86.2%), which we regard as a very good result. All patients consider the surgery successful and are satisfied with the outcome. No patient reported recurrent dislocation. DISCUSSION When treating the posterior dislocation of the shoulder, vital is the shoulder reducibility and also the presence or the size of reverse Hill-Sachs defect. The transfer of the subscapularis tendon can be performed as an open procedure or arthroscopically. Inveterate irreducible posterior dislocation of the shoulder is quite a rare diagnosis, which is why even at our department the McLauglin procedure is performed in the order of units per year only. CONCLUSIONS The surgical solution of inveterate posterior dislocation of the shoulder is hardly ever uncomplicated. The reduction alone is often insufficient and some other way of shoulder stabilisation is necessary, often times addressing the humeral head defect. In our to date experience, the McLaughlin procedure or the Neer s modification is an elegant and safe method to treat posterior dislocation with a humeral head defect. The functional outcomes are very good and enable the patients to reengage in everyday activities. Thanks to this procedure shoulder joint arthroplasty can be avoided in younger patients. Nonetheless, in defects that are greater than 50% of the head the replacement is necessary. Due to frequently associated rotator cuff injuries, the most often procedure indicated by us is the reverse total shoulder replacement. Key words: posterior dislocation of the shoulder, reverse Hill-Sachs defect, McLaughlin procedure, Neer s modification.

• MeSH
• dospělí MeSH
• hlavice humeru diagnostické zobrazování   chirurgie   MeSH
• kompresivní fraktury * MeSH
• lidé středního věku MeSH
• lidé MeSH
• luxace ramenního kloubu * diagnóza   chirurgie   MeSH
• ramenní kloub * chirurgie   MeSH
• rameno MeSH
• retrospektivní studie MeSH
• rozsah kloubních pohybů MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Bio-absorbable anchors are widely used for Bankart repair in shoulder instability surgery. Suture anchor placement for labral repair may give rise to osteolysis and/or create stress risers in the glenoid rim, which may be the underlying reasons for glenoid rim fracture with a fracture line passing through previous anchor placement sites, the so-called "postage stamp fracture". Intraarticular fractures of the glenoid have been treated via open reduction and internal fixation through an arthrotomy, which may lead to potential postoperative complications like infection, neurovascular injuries, joint stiffness, and a long recovery period. Thus, arthroscopic techniques for the reduction and fixation of glenoid fractures have been developed. We present a case of anterior glenoid rim postage stamp fracture 9 years after glenohumeral instability surgery in a 29- year-old male. The fracture and recurrent instability were treated via arthroscopic Bankart revision repair and arthroscopic assisted percutaneous screw fixation, where the arthroscopic fracture reduction and definitive fixation were performed separately and before Bankart repair, which is different from the techniques defined in the literature previously. The patient was able to return to work at 6 weeks, to fitness training without pain or restriction at 3 months, and contact sports 6 months postoperatively. Key words: Bankart fractures, bony Bankart lesion, osseous Bankart lesion, shoulder dislocation, arthroscopy.

• MeSH
• artroskopie MeSH
• dospělí MeSH
• filatelie * MeSH
• kostní šrouby MeSH
• lidé MeSH
• lopatka MeSH
• luxace ramenního kloubu * chirurgie   MeSH
• nestabilita kloubu * etiologie   chirurgie   MeSH
• ramenní kloub * chirurgie   MeSH
• recidiva MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

• MeSH
• externí fixátory využití   MeSH
• fixace fraktury klasifikace   metody   MeSH
• fraktury humeru diagnostické zobrazování   chirurgie   MeSH
• fraktury kotníku diagnostické zobrazování   chirurgie   MeSH
• hlavice humeru diagnostické zobrazování   chirurgie   zranění   MeSH
• lidé MeSH
• luxace ramenního kloubu * diagnostické zobrazování   chirurgie   MeSH
• metakarpální kosti diagnostické zobrazování   chirurgie   zranění   MeSH
• poranění prstů ruky chirurgie   MeSH
• poranění ruky diagnostické zobrazování   chirurgie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• souhrny MeSH

A rare case of a fracture of the anatomical neck of the humerus associated with a posterior dislocation of the shoulder in a 43-year-old man is presented. It was managed by immediate surgery using locking plate osteosynthesis. The shoulder was immobilised for 5 weeks in a Gilchrist brace. The outcome was very good with a full range of motion and a stable shoulder at 1 year after injury, with no signs of avascular necrosis of the humeral head. The aetiology of this injury and possibilities of its treatment are discussed. Key words: shoulder dislocation, humeral fractures.

• MeSH
• dospělí MeSH
• fraktury humeru patologie   patofyziologie   chirurgie   MeSH
• hlavice humeru patologie   patofyziologie   chirurgie   MeSH
• kostní destičky MeSH
• lidé MeSH
• luxace ramenního kloubu patofyziologie   chirurgie   MeSH
• rozsah kloubních pohybů MeSH
• vnitřní fixace fraktury přístrojové vybavení   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The aim of this study was to present the results of surgical treatment in two male patients with chronic locked posterior dislocation of the shoulder, who underwent total shoulder arthroplasty due to destruction of more than 45% of the humeral head articular surface and glenoid impairment. The deltopectoral approach was used in both cases. Total shoulder arthroplasty (Epoca-Synthes) was carried out in the standard manner. Case one: A 29-year-old, extremely obese patient suffered injury to his shoulder during an epileptic seizure. At 11 months after injury, surgery was performed using an interscalene plexus block because general anaesthesia presented a high risk for the patient. The total follow-up period was 4 years. Between the 2nd and the 3rd follow-up year, the patient lost about 46% of his body weight. At the first year, when the patient maintained his initial overweight, shoulder elevation was 170° and range of motion was not restricted. The overall Constant Score (CS) was 96. Due to a massive weight loss, muscle strength was reduced and the CS decreased to 82. Case two: A 41- year-old man injured his shoulder in a fall and, due to a late diagnosis, underwent surgery under general anaesthesia at 11 months after injury. At 3-year follow-up the overall result was excellent, with only slightly limited internal rotation of the shoulder.

• MeSH
• artroplastika ramenního kloubu metody   MeSH
• dospělí MeSH
• lidé MeSH
• luxace ramenního kloubu chirurgie   MeSH
• následné studie MeSH
• poranění ramene MeSH
• ramenní kloub chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH