The stapling operation for recurrent dislocation of the shoulder was first described by du Toit in Johannesburg, South Africa in 1956. This operation seems to be a reliable procedure for fixing a detached glenoid labrum, the principal pathological lesion which causes recurrent dislocation. It is technically easier than the Bankart procedure as it is possible to reattach the detached labrum and capsule, as well.
A summary of the operative techn i que is as follows. An 8cm incision is made over the deltopectral groove. The short head of the biceps and coracobrachialis are retracted medially. The subscapularis is divided along its fibers and retracted upward and downward. The capsule is incised parallel to the fibers of the subscapularis. After a special humeral head retractor is inserted, the joint is inspected and pathological lesion should be identified. Two staples should be inserted to secure the detached labrum and redundant capsule. Care must be taken so that the staples do not penetrate the articular surface. During the procedure, no tendon or muscle is detached from its origin or insertion. Therefore, postoperative management is easier and early recovery to usual activities can be expected.
The authors have performed du Toit procedure on 6 patien t s who had recurrent anterior dislocation of the shoulder. Individual data of the 6 patients were summarized in table 1, and also, the follow-up results were shown in table 2. A few patients felt some dull pain occasionally, but no patients had any redislocations. Most patients resumed their sports activities within 3 to 6 months. Most of the patients had some limitation of external rotation, because the authors were too nervous to recommend that the patients do external rotation exercises soon after surgery. In spite of this limitation, no one complained of any disturbances in performing daily or sports activitties.
In summary, du Toit's stapling o peration is directed to repair the pathology of the dislocation. No detachment or transection of the muscles is necessary to perform the procedure, for this reason, early resumption of occupation and sports participation can be expected. The only disadvantage of this procedure is that implantation of metal staples is necessary, and these may loosen, break or require removal. Even though these disadvantages have been taken into consideration, we believe the du Toit capsulorrhaphy is a reliable and useful procedure for recurrent dislocation of the shoulder.
