The Shoulder Joint Stabilization In Glenoid Bone Defect According To The Latarge Method With The New Human Ladder Creation.

Abstract

Relevance. Patients’ treatment with habitual shoulder dislocation is an urgent problem of modern traumatology and orthopedics. The frequency and severity of damage to the shoulder joint is largely due to the structural features, biomechanics and high functional requirements for it. In more than 85% cases of shoulder joint chronic instability, there is bone damage to the anterior - lower part of the articular process of the scapula. Therefore, surgical techniques that compensate for a bone defect have an advantage.

Study purpose: Optimization and improvement of the stabilizing effect of Latarge surgery with the creation of a new humeral-scapular ligament, as well as to reduce the trauma of surgery.

Material and research methods: From November 2013 to June 2019, a study was carried out in the SBRSSPMCTO clinic in 23 patients who were on inpatient examination, diagnosed with chronic post-traumatic anteromedial instability of the shoulder joint with a bone defect of the glenoid. The study group included 19 men and 4 women aged 15-44 years (mean 22.4 years). The inclusion criteria for the study were more than 20% glenoid bone defect.

Results and its discussion: All patients underwent MSCT with 3D reconstruction of the operated shoulder joint in a planned manner 6 months after the operation. Bone fusion of the graft was obtained in 19 patients; fibrous fusion of the graft was obtained in 3 patients.  In 1 patient, partial resorption of the graft was found, but in this patient the function and stability of the shoulder joint were not impaired.

Conclusion: Thus, the non-free bone grafting of the scapula according to Latarge, as well as the creation of a new shoulder-scapular ligament in the surgical treatment of patients with instability of the shoulder joint and large defects of the articular surfaces can reduce the trauma of the operation, increase its stability and anatomicality. The proposed operation is indicated in patients with chronic instability of the shoulder joint with an accompanying bone defect of the glenoid, where the bone defect is 20% or more.