Front Matter - The Journal of Bone & Joint Surgery

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.