Dr Dipit Sahu

Dr Dipit Sahu

Dr Dipit Sahu is a Shoulder Surgeon and also a founder of the Mumbai Shoulder Institute in Mumbai.

Website URL: http://mumbaishoulder.com Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

The biggest series of patients from Zurich published in the top ranked journal of orthopaedics (JBJS) proves beyond doubt that Latarjet is clearly the surgery of choice and much more superior to Arthroscopic bankart repair for treatment of anterior recurrent dislocation of shoulder.

People have been arguing back and forth in favor of arthroscopic bankart repair, while secretly accepting it has a high failure rate. The simplicity and the arthroscopy nature of the surgery make it an attractive choice for the treating physician, while at the same time it is prone to high chances of failure.

This biggest series of patients by Prof Gerber who is one of the most respected and top-notched shoulder surgeons of Europe says that arthroscopic bankart repair has a recurrence and failure rate of 30% which is quite unacceptable. Latarjet surgery on the other hand has a very low failure rate of only 3%.

Other advantages of latarjet are that the patient returns to normal activity in as less as 2-3 weeks after the surgery while after bankart repair it may take 6-8 weeks. The authors followed up their patients for a period of 10 years and found that as the follow up increased the failure rate of bankart repair also increased. Follow ups of latarjet surgery, however, did not show this trend and had very few failures on follow up.

My own series of approximately 100 latarjetpatients has shown excellent outcomes with no failures. The surgery also costs much less as compared to bankart repair. It’s actually a French procedure started by Michele Latarjetin 1954 and improved and popularized by Giles Walch from Lyon who is one of the geniuses in the world of shoulder surgery. The surgery involves cutting the coracoid at its base and transferring it along with the conjoint tendon through the subscapularismuscle and fixing it on medial glenoid neck with the help of two malleolar screws. Latarjet is also the treatment of choice in high demand contact athletes as their shoulders face higher stresses during contact sports.

Most of the minimally displaced proximal humerus fractures in people > 65 years age will unite uneventfully ant the outcomes will be good. However sometimes these fractures are moderately to severely displace and may be accompanied with a head dislocation.

The bone of contention is the highly comminuted and displaced fractures, which pose a significant challenge for the treating physician

Recent literature suggests that in elderly age group, the displaced proximal humerus fractures can also be treated conservatively with outcomes that are comparable to those of a shoulder hemi replacement. What that means it that the average shoulder flexion attained will be around 90-100 degrees in both the scenarios. Sometimes the fractures that are treated non-operatively will not unite. Those fractures will then have to be operated upon and either replaced or fixed with plate etc.

A word of caution with reverse shoulder replacement is that if it fails sometime in the future, the revision is fraught with many complications. Sometimes even a hemi replacement fails and may need to be converted to a reverse shoulder replacement which again has a very high complication rate. So the path to reverse shoulder replacement, although rewarding should be chosen carefully only after giving a good thought to the potential risks ahead

injectSteroids are often spoken of, in a rather dismissive tone, given its bad reputation for causing serious side effects. However, local application of steroids especially local / regional injections of steroid are one of the best blessings of the medicine world. For e.g. local bursitis or inflammation in the shoulder may take days to respond to rest, cold fomentation or medicines, but one local injection of thesteroid in the shoulder gives you instant relief.

In intractable painful conditions of the shoulder, it is even more important to give local steroid injections. The only caution to be used is touse it in the correct site and for the correct indication. For e.g. a sub-acromial bursitis will readily respond to sub-acromial injection, an intra-articular injection may be best used in tendon inflammation. Frozen shoulder responds very well to steroid injections. There are different preferences w.r.t the site of steroid injections is case of a frozen shoulder. However, unequivocally a sub-acromial injection does not seem to work in case of a frozen shoulder. Injecting in the gleno-humeral joint space (a.k.a intra articular) has been a practice with some physicians. But an intra articular injection fails as often as it succeeds. The best outcomes in frozen shoulder are obtained by injecting steroids in the Supra scapular nerve (SSN) space. There are many methods advocated to practice SSN space injection. This injection works to reduce the pain and improves the exercise range of the affected individual.

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