-
Select a Community
- MB 1 Preclinical Medical Students
- MB 2/3 Clinical Medical Students
- ORTHO Orthopaedic Surgery
-
About Bullet Health
Please confirm topic selection
Are you sure you want to trigger topic in your Anconeus AI algorithm?
Primary Shoulder Instability in 17M
HPI
A 17-year-old male lacrosse player, right-hand dominant, presents after his second left shoulder dislocation that occurred while boogey boarding in the ocean 2 days ago. His first left shoulder dislocation occurred 6 months ago at lacrosse practice in the middle of his junior season. He has never had a dislocation on his dominant right shoulder. He is a competitive player (position is attacker) who is currently a senior in high school and has been accepted to a Division 1 school to play lacrosse on a scholarship.
PMH
Otherwise healthy. No prior surgery.
PE
On physical exam, his left shoulder is acutely painful. He has apprehension at terminal range abduction and external rotation. He does not have apprehension in mid-abduction. His cuff strength is intact. His axillary nerve is intact.
1.
In addition to AP and LAT radiographs of the shoulder, would you obtain any other imaging to guide management?
No - AP and LAT radiographs of the Shoulder are sufficient
0%
1/332
Yes - additional radiographic views (aXR)
1%
6/332
Yes - Shoulder CT (CT)
6%
20/332
Yes - Shoulder MRI (MRI)
46%
156/332
Yes - aXR + CT
2%
8/332
Yes - aXR + MRI
15%
50/332
Yes - CT + MRI
18%
60/332
Yes - aXR + CT + MRI
6%
23/332
Yes - Other
0%
1/332
Outside my area of expertise - best if I don't vote
2%
7/332
2.
How would you manage this patient at this time?
Nonoperative
11%
34/309
Operative
86%
266/309
Outside my area of expertise - best if I don't vote
2%
9/309
3.
If you choose Operative Management, what treatment would you perform?
I would not choose Operative management
2%
6/292
Soft Tissue Procedure +/- remplissage (includes Labral Repair, Bony Bankhart)
73%
216/292
Free Bone Block +/- remplissage (ex. DTA)
1%
5/292
Latarjet Coracoid Transfer +/- remplissage
16%
47/292
Other / Other Combination of Above
0%
1/292
Outside my area of expertise - best if I don't vote
5%
17/292
4.
If you choose Operative management, beyond what threshold of anterior glenoid bone loss would you perform a Bone Reconstruction procedure (Free Bone Block, Latarjet Coracoid Transfer) for this patient?”
I would never perform a Bone Reconstruction procedure regardless of % glenoid bone loss
2%
6/279
< 10%
2%
6/279
10-15%
21%
59/279
16-20%
27%
78/279
21-25%
22%
64/279
26-30%
7%
22/279
> 30%
5%
14/279
Outside my area of expertise - best if I don't vote
10%
30/279
5.
If you choose a Soft Tissue Procedure (ex. Labral Repair, Bony Bankhart), would you do it Open or Arthroscopically?
I would not choose Labral Repair/Soft Tissue Procedure (STP) Alone +/- remplissage
3%
10/265
Arthropscopic
82%
218/265
Open
9%
25/265
Outside my area of expertise - best if I don't vote
4%
12/265
6.
If you choose an Arthroscopic Soft Tissue Procedure, would you perform a remplissage?
I would not choose a Arthroscopic Soft Tissue Procedure / Labral Repair (STP) Alone
3%
9/264
Yes - I would perform a remplissage
39%
104/264
No - I would not perform a remplissage
18%
48/264
Maybe - Depends on my Intraoperative Findings
31%
83/264
Outside my area of expertise - best if I don't vote
7%
20/264
7.
If you choose a Free Bone Block +/- remplissage for the glenoid, would you do it Open or Arthroscopically?
I would not choose a Free Bone Block +/- remplissage
24%
63/259
Arthroscopic
23%
61/259
Open
44%
115/259
Outside my area of expertise - best if I don't vote
7%
20/259
8.
If you choose a Free Bone Block +/- remplissage for the glenoid, what bone graft would you use?
I would not choose a Free Bone Block +/- remplissage
27%
70/258
Autograft - ICBG
24%
64/258
Autograft - Distal Clavicle
8%
23/258
Autograft - Scapular Spine
2%
6/258
Allograft - Distal Tibia
10%
27/258
Allograft - Distal Radius
3%
8/258
Autograft - Other
7%
19/258
Allograft - Other
3%
10/258
Outside of my area of expertise - best if I don't vote
12%
31/258
9.
If you choose a Free Bone Block +/- remplissage for the glenoid, how do you repair the capsule?
I would not choose a Free Bone Block +/- remplissage
27%
67/243
I do not repair the capsule
9%
22/243
To the native glenoid, making bone block extra-capsular
29%
72/243
To the bone block, making the bone block intracapsular
22%
54/243
Outside my area of expertise - best if I don't vote
11%
28/243
10.
If you choose a Latarjet Coracoid Transfer +/- remplissage, what would be your technique
I would not choose a Latarjet Coracoid Transfer +/- remplissage
24%
59/241
Open - French Technique
29%
70/241
Open - Congruent Arc Technique
19%
48/241
Arthroscopic - French Technique
5%
13/241
Arthroscopic - Congruent Arc Technique
4%
12/241
Outside my area of expertise - best if I don't vote
16%
39/241
11.
If you choose to perform a bone reconstruction procedure (Free Bone Block, Latarjet), how would you fix your bone graft to the glenoid?
I would not choose a bone reconstruction procedure (Free Bone Block, Latarjet)
21%
51/233
Stand-Alone Screws - Non Cannulated
12%
29/233
Stand-Alone Screws - Cannulated
42%
99/233
Mini Plate - Non Cannulated Screws
1%
4/233
Mini Plate -Cannulated Screws
4%
11/233
Cortical Button - Single
0%
1/233
Cortical Button - Double
3%
9/233
Suture Anchors
3%
7/233
Outside of my area of expertise - best if I don't vote
9%
22/233
12.
If you choose an Arthroscopic Soft Tissue Procedure with remplissage, when would you allow the patient to return to contact sports?
I would not choose a Soft Tissue Procedure / Labral Repair (STP) Alone
2%
6/245
2-3 months
5%
13/245
4-5 months
11%
29/245
6-7 months
48%
119/245
8-9 months
18%
46/245
10-11 months
2%
7/245
12 months or greater
3%
9/245
Outside of my area of expertise - best if I don't vote
6%
16/245
PROCEDURE #1
DOP: 5/25/2021
Arthroscopic Bankart Repair and Remplissage
POLL#
SURGEON CHOICE
1
In addition to AP and LAT radiographs of the shoulder, would you obtain any other imaging to guide management?
Yes - CT + MRI
2
How would you manage this patient at this time?
Operative
3
If you choose Operative Management, what treatment would you perform?
Soft Tissue Procedure +/- remplissage (includes Labral Repair, Bony Bankhart)
5
If you choose a Soft Tissue Procedure (ex. Labral Repair, Bony Bankhart), would you do it Open or Arthroscopically?
Arthropscopic
6
If you choose an Arthroscopic Soft Tissue Procedure, would you perform a remplissage?
Yes - I would perform a remplissage
12
If you choose an Arthroscopic Soft Tissue Procedure with remplissage, when would you allow the patient to return to contact sports?
6-7 months
Intra-procedure P1