What are the types of anterior shoulder dislocation (dislocation of the shoulder joint) in pediatric patients (children)?

From the Guidelines

Anterior dislocations in children primarily include traumatic anterior shoulder dislocations, which are the most common type and often occur during sports or falls, with the humeral head being forced anteriorly out of the glenoid fossa 1. These dislocations can be further classified based on the direction of dislocation, with anterior dislocations being the most common type. The management of anterior dislocations in children typically involves prompt reduction, appropriate immobilization, and rehabilitation, with surgical intervention sometimes necessary for associated fractures or recurrent instability. Key considerations in the management of anterior dislocations in children include the potential for growth disturbances, avascular necrosis, or chronic instability, particularly in children with open growth plates 1. Some of the key factors that influence the management of anterior dislocations in children include the age of the child, the severity of the dislocation, and the presence of any associated injuries. In general, the goal of management is to achieve prompt and stable reduction of the dislocation, while minimizing the risk of long-term complications. This can often be achieved through a combination of conservative and surgical management strategies, with the specific approach depending on the individual circumstances of the case. Overall, the management of anterior dislocations in children requires a careful and individualized approach, taking into account the unique needs and circumstances of each patient. The most recent and highest quality study on this topic is from 2018, which highlights the importance of prompt and appropriate management of anterior dislocations in children to prevent long-term complications 1. Some of the key findings from this study include the importance of assessing both osseous and labroligamentous pathology in patients with shoulder dislocation or instability, and the potential need for bone grafting to restore stability in cases with significant glenoid bone loss. These findings have important implications for the management of anterior dislocations in children, and highlight the need for a careful and individualized approach to each case. In terms of specific management strategies, the study suggests that prompt reduction, appropriate immobilization, and rehabilitation are key components of effective management, with surgical intervention sometimes necessary for associated fractures or recurrent instability 1. Overall, the study provides important insights into the management of anterior dislocations in children, and highlights the need for a careful and individualized approach to each case.

From the Research

Types of Anterior Dislocation in Children

• Anterior dislocation of the glenohumeral joint is a common upper extremity injury in orthopedic and emergency medicine 2
• The management of anterior shoulder instability in young patients remains an evolving and controversial topic 3
• Recurrent dislocation was the primary outcome of interest in most studies, with several systematic reviews reporting the recurrence rate for young patients to be >70% 3

Classification of Anterior Dislocation

• Primary anterior dislocation: occurs in patients who have not had a previous dislocation 4
• Recurrent anterior dislocation: occurs in patients who have had a previous dislocation 4
• Anterior dislocation with associated fractures: such as fractures of the greater tuberosity 2

Treatment Options

• Immobilization with the arm tied with a bandage to the torso for three to four weeks after reduction of the dislocation 4
• Use of a sling, which is discontinued after the patient is comfortable 4
• Surgical stabilization, which is becoming more frequently performed, especially in patients with bony Bankart lesion, ALPSA lesion, bipolar injury, or off-season injury in an overhead or throwing athlete 5
• Gentle traction, abduction, and external rotation maneuver under sedative-free for reduction of acute anterior shoulder dislocation 6

Prognosis

• The type and duration of the initial treatment had no effect on the rate of recurrence 4
• The presence of an evident Hermodsson (Hill-Sachs) lesion on radiographs at the time of the primary dislocation was associated with a significantly worse prognosis with regard to recurrence 4
• Post-dislocation arthropathy was found in 20% of shoulders at the ten-year follow-up examination 4