Front Matter - The Journal of Bone & Joint Surgery

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SO cc. VlsI (Prsnuuced Xi l6csisl XYLOCAIN E HYDUOCHLOfl IDE flkAp4*OI UI)OCAINE llVI)ltOCLOl(IDE !fl’lt%. I’iIARMACEIJT CAL PIIODLICTS, I NC. WOI4CE5TEI4,MM.S., U.S.A. Iii aI1svelil1g :ttlvert i/(lfl(ists, J)1(aS( Iflelitioll ilte Journ(1l of Bone and Joint Suryery. 36
VOL. 38-A, NO. 1 JANUARY 1956 The Journal of Bone and Joint Surgery American Volume RECURRENT DISIA)CATIOX OF THE SHOULI)EH A TWENTY-FOUR YEAR STUDY OF THE .JOHANNEsBuRG STAPLING 01EIATIoN BY G. ‘F. DU TOI’r, F.1t.(.S. (ING.), .#{149}N D. ItOUX, JOH.NNIlIUItG, $OU’I’II .FItI(. Iiiii, th( I)e/)(lrt,,unt of Orthopaedir., II itt:’ute,sI(IIul ( ‘a iiei.sity, .10/1(10 11(.Sh)l1I(/ Flie autliots have reviewed 210 cases of 1e(uI’I’eIlt diSlO(ttti()II of the shoulder tI’eated IJY repair of the demonstrable lesion. Iii each case the detached labrum or the toni capsule was pinned to the rim of the glenoid cavity with staples and as far as possible nothuig else was done at operation to alter the mechanics of the shoulder. Most of the operations 111 this series were performed by the authors themselves, but a few were performed by other members of the senior staff of the University general, industrial, and military hos- pita! units (from 1930 onw-ard). 115 analyzing the results obtained in these cases, the authors discarded sixty cases because of inadequate records. In the remaining 150 cases, careful records and adequate follow-up had beeti maintained, and the available data was regarded as reliable. Although recurrent dislocation of the shoulder can apparently be cured in a number of different ways, the search has been for a procedure which is based on a recognition of the pathological lesion and which restores the anatomy without inflicting positive damage. DEVELOPMENT OF TIlE STAPLING OPERATION In South Africa the Bankart repair of a sheared-off fibrocartilaginous labrum was first performed by F. P. Fouch#{233}and A. Lewer Allen. The technical difficulties found by these men in the use of the Bankart method gave rise to the idea of fixation by stapling. The first stapling operation was performed in 1931 by Fouch#{233}. In this operation he used chisel-pointed staples made of bicycle spokes and a piston-type introducer designed by Allen. The staples were driven in extra-articularly, pinning the capsule to the glenoid I’im. Since 193!, the technique and instruments used in this operation have been perfected by minor modifications. Conical-pointed stainless-steel staples have been adopted because they show less tendency to twist out of alignment than do the chisel-pointed staples, and an improved staple introducer is now in use. Widening of the exposure l)y division of the coracoid process has been found to be redundant, and the worth of ititra-articular stapling was tested and proved by A. D. Polonsky in 1931. As confidence in the stapling method has increased, speedier postoperative mobilization has been carried out. Our longest follow-up is that of a medical man treated by Polonsky in 1931. Although the other procedures still have their adherents 1,13,15, the stapling operation has gained increasing support. It was demonstrated to Brig. H. Ogilvie during the War, and he published a report on it in 1946. Downing also referred to the stapling operation * Read at the Annual Meeting of The American Academy of Orthopaedic Surgeons, Los Angeles, California, February 2, 1955.
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