Complex Functional Posttraumatic Shoulder Reconstruction Using Shoulder Arthroplasty and a Pedicled Innervated Latissimus Dorsi Flap—A Case Report and Literature Review

Abstract

BackgroundThe shoulder joint is one of the most freely movable joints in the human body and has therefore high importance for upper limb functionality. Several techniques have been developed to replace the glenohumeral joint including humeral hemiarthroplasty, anatomical total shoulder arthroplasty, and reverse total shoulder arthroplasty, depending on the underlying pathology. For the soft tissue reconstruction, the innervated latissimus dorsi musculocutaneous flap is a reliable solution flap in shoulder and arm reconstruction.Case presentationWe present the case of a 16‐year‐old male patient with a complete destruction of the shoulder joint and soft tissues after ballistic trauma. We performed the reconstruction of the shoulder joint using a humeral hemiarthroplasty with a mesh fixation to the remaining glenoid. The soft tissue coverage and the restoration of the deltoid muscle function were insured with a pedicled innervated latissimus dorsi musculocutaneous flap. One year postoperatively, the patient showed a good function of the shoulder joint with an excellent aesthetical result and no pain.ConclusionThe pedicled latissimus dorsi musculocutaneous flap can safely restore the shoulder function, while the humeral hemiarthroplasty with mesh fixation can be a reliable solution for the reconstruction of a completely destructed shoulder joint.

Shoulder and Elbow Surgery Special Issue

“…The elbow section of this issue includes papers on arthroscopy, 1 open surgery in elbow stiffness, 2,3 fractures, 4 total elbow arthroplasty, 5 and conservative methods of treatment 6 . The shoulder section addresses a multitude of anatomic details as well as techniques, including clavicular shaft and distal fractures, acromioclavicular joint traumatic and degenerative conditions, 7–11 rotator cuff pathologies and fixation techniques, treatment of the post‐surgical or post‐traumatic glenohumeral stiffness, fractures of the proximal humerus, 5,12–21 the safety of irrigation in the shoulder arthroscopy, management of the scapular and glenoid fractures, radiologic and 3D models 22–31 …”

“…6 The shoulder section addresses a multitude of anatomic details as well as techniques, including clavicular shaft and distal fractures, acromioclavicular joint traumatic and degenerative conditions, [7][8][9][10][11] rotator cuff pathologies and fixation techniques, treatment of the post-surgical or post-traumatic glenohumeral stiffness, fractures of the proximal humerus, 5,[12][13][14][15][16][17][18][19][20][21] the safety of irrigation in the shoulder arthroscopy, management of the scapular and glenoid fractures, radiologic and 3D models. [22][23][24][25][26][27][28][29][30][31] Overall, this special issue contains plenty of meaningful readings for surgeons specializing in shoulder and elbow surgery and for general orthopaedic and trauma specialists, as well as for orthopaedic residents and young surgeons worldwide. Enjoy reading, sharing the data and the wonderful illustrations from this special issue, and we look forward to receiving your feedback.…”

“… 6 The shoulder section addresses a multitude of anatomic details as well as techniques, including clavicular shaft and distal fractures, acromioclavicular joint traumatic and degenerative conditions, 7 , 8 , 9 , 10 , 11 rotator cuff pathologies and fixation techniques, treatment of the post‐surgical or post‐traumatic glenohumeral stiffness, fractures of the proximal humerus, 5 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 the safety of irrigation in the shoulder arthroscopy, management of the scapular and glenoid fractures, radiologic and 3D models. 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 …”