A novel modified McLaughlin surgery for treating locked chronic posterior shoulder dislocation

Abstract

Background Posterior shoulder dislocation is an uncommon orthopaedics injury and is frequently missed or misdiagnosed, accounting for 2%-4% of all shoulder dislocations, and is associated with the reverse Hill-Sachs lesion. Once posterior shoulder dislocation develops into a chronic disease, it will bring a lot of trouble to the treatment, especially in repairing the humeral defects. Surgical strategies are also developing and innovating to deal with this injury, including transfer of subscapularis tendon or lesser tubercle, humeral rotational osteotomy, autogenous bone graft or allograft. Shoulder replacement seems to be the ultimate and only option when the injury becomes irreparable, although some studies have shown unsatisfactory follow-up results. Considering no gold-standard treatment for locked posterior shoulder dislocation, we described a novel modified McLaughlin procedure for locked chronic posterior shoulder dislocation and evaluated the functional outcomes. Methods This study included five locked chronic posterior shoulder dislocation patients with an associated reverse Hill-Sachs lesion, in which the compression surface covered 30–40% of the humeral head. The mean period from injury to receiving surgery was 11.6 weeks (6–24 weeks). All five patients underwent the modified McLaughlin procedure, mainly divided into three steps, including open reduction, transfer of the partial lesser tuberosity and artificial bone to repair the reverse Hill-Sachs defects. The kernel technique was to fix the transferred tuberosity with two lag screws and strengthen it with two Ethibond sutures. The Constant-Murley score (CMS), the range of shoulder motion and the complications were recorded to assess and compare the functional situation of the shoulder postoperatively and postoperatively. Results After an average of 19.8 months (12–30) of follow-up, the mean CMS improved to 85.8 ± 4.9 (79–91) compared with 46.0 ± 4.5 (40–52) preoperatively, which showed a significant difference (p = 0.001). In the final follow-up, all five patients showed no symptoms of shoulder instability, and there was no pain or limited activity in daily life, thus all patients were satisfied with the results. Conclusion Repairing the reverse Hill-Sachs lesion by transferring the partial lesser tuberosity combined with artificial bone fixed by lag screws and sutures can ensure shoulder stability and provide pain relief and good function in patients with locked chronic posterior shoulder dislocation associated with the humeral head defect.

From Diagnosis to Decision-Making: A Systematic Review of the Management of Reverse Hill-Sachs Lesions after Posterior Shoulder Dislocations

“…Post-operative weighted average flexion was 137.1 (107.1-157.7). Pre-operative abduction was reported only by 4 studies [28,[31][32][33]; the weighted average was 44.4 • (13.3-95); and the post-operative abduction weighted average was 136.6 (95.8-171.4).…”

“…Pre-operative weighted average external rotation with the adducted arm was 1.3 • (−6.7-8.3 • ) and post-operatively it increased to 45.4 • (35-79.2). Eight studies reported the external rotation range with the abducted arm and the average post-operative value was 72.2 • (51-83.6) [5,6,21,25,26,29,32,33]. Pre-operatively average weighted internal rotation was 9.4 • (1-25) and was reported in three studies [5,29,31].…”

“…Several clinical scores were used: Constant Murley Score (CMS), American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) activity score; Subjective Shoulder Value (SSV) score, ROWE score, Walch score, Disability of the Arm Shoulder and Hand (DASH) score, Western Ontario Shoulder Instability Index (WOSI), Visual Analog Score (VAS). Only three studies reported the pre-operative CMS with a mean value of 29 points [5,26,33]. The weighted average CMS found at the post-operative clinical evaluation was 79.4 (59-94) and was reported in 9 studies [5,8,[22][23][24][26][27][28]33].…”

“…Diklic et al [8] reported data from one patient who fell after a seizure; therefore, the reason for the posterior shoulder dislocation could not be determined. Three studies [5,6,33] did not report the cause of the dislocation of their population.…”

All-Arthroscopic Management of Locked Posterior Shoulder Dislocation: Reduction Under Direct Visualization and Treatment of Intra-articular Pathologies

“…When treating PSD and reducing shoulder injuries, arthroscopic 10 is preferred over open 17 procedures due to their minimally invasive approach and the ability to visualize the articular surface and the posterior capsulolabral junction. This allows for better centering of the humeral head through direct visualization.…”