Old tient with chronic shoulder dislocation 6 months with bony defect more than 50% the best treatment is:
- a. Hemiarthroplasty
- b. Total shoulder arthroplasty
- c. Conservative
- d. Repair of the defect
The best treatment for an older patient with a chronic shoulder dislocation that has been present for six months and has a bony defect of more than 50% of the articular surface is total shoulder arthroplasty (TSA). This is because the bony defect is too large to be repaired and the shoulder joint is already damaged.
Here's a detailed explanation:
Chronic Shoulder Dislocation:
When the humeral head, the ball-shaped bone in the shoulder joint, dislocates, it usually pops back into place within a few minutes. However, in some cases, the dislocation can become chronic, meaning it stays out of place for more than a week or two. This can lead to damage to the surrounding cartilage and ligaments, making it difficult for the shoulder to return to its normal position and function.
Bony Defect:
A bony defect in the shoulder joint occurs when there is a loss of bone from the articular surface, the area where the humeral head and glenoid fossa (the socket in the shoulder joint) meet. This can happen due to trauma, such as a dislocation, or from wear and tear over time. Bony defects can contribute to instability and pain in the shoulder.
Treatment Options:
The treatment for a chronic shoulder dislocation with a bony defect depends on the size of the defect and the overall health of the patient.
a. Hemiarthroplasty:
This surgery replaces only the humeral head with an implant. It is a good option for patients with smaller bony defects and good bone quality in the glenoid fossa.
b. Total Shoulder Arthroplasty:
This surgery replaces both the humeral head and the glenoid fossa with implants. It is a more durable option and can restore full range of motion, but it is also a more complex surgery with a longer recovery time.
c. Conservative Treatment:
This may include physical therapy, activity modification, and pain medication. It can be successful in some cases, but it is not likely to be sufficient for patients with large bony defects and significant instability.
Best Treatment for Older Patient:
In the case of an older patient with a chronic shoulder dislocation for over six months and a bony defect of more than 50%, total shoulder arthroplasty is generally considered the best option. This is because the bony defect is too large to be repaired and the shoulder joint is already damaged. Hemiarthroplasty may not provide adequate stability or function in this situation. Conservative treatment is less likely to be successful in the long run.
Considerations:
The final decision of the most suitable treatment will depend on the specific circumstances of the patient, including their age, activity level, overall health, and surgeon's preference. An orthopedic surgeon will thoroughly assess the patient's condition and discuss the various treatment options to determine the best course of action.
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Orthopedics