Humeral head impression fracture in acute posterior shoulder dislocation: new surgical technique

Abstract

Posterior shoulder dislocation with humeral head impression fracture is rare and its early diagnosis and treatment remain a challenge for the orthopaedic surgeon. Although literature describes several surgical options, most are based on the detachment of the subscapularis or on more complex techniques that change the humeral joint anatomy even more. This report describes a new operative technique that is only slightly invasive, where the depressed chondral surface is raised to regain a normal articular contour. The chondral surface is supported by an interference biabsorbable screw and the insertion of the subscapularis tendon is left intact. Two male patients with an acute shoulder posterior dislocation associated with anteromedial impression fracture of about 40 and 50%, respectively, of the articular humeral shape were treated in our department. The average follow-up was 26 months where plain X-ray and CT scan showed an anatomical humeral surface free from signs of arthritis or necrosis. Functional results were excellent in both cases. This new technique is easy, less invasive than others and ensures a stable cartilage and subchondral support without the use of grafts.

Arthroscopy-assisted reduction of impression fracture of the humeral head: A case report

“…5,6 Recently, open surgical elevation of an impression in the articular surface was reported. 2 In this case, the impression of the articular surface was not large or comminuted on CT scan, and we ascertained by arthroscopy that the articular cartilage was healthy. Therefore, we attempted an arthroscopic elevation and achieved a good result.…”

Anatomical Reconstruction of Reverse Hill-Sachs Lesions Using the Underpinning Technique

“…Assom et al 18 described an open retrograde technique through a cortical window that uses a bioabsorbable screw after elevation of the depressed articular cartilage through the rotator interval without jeopardizing the subscapularis in his series of 2 patients. However, the techniques described by Assom et al 18 proximal humeral fracture occurs that prevents the use of a cortical window for the elevation of the lesion. It is also technically challenging to approach the entire extent of the humeral head lesion through the rotator interval without jeopardizing the subscapularis, especially for lesions .30%.…”

Recurrent posterior dislocation of the shoulder associated with the Buford complex

“…Repair of RPDS includes repair of the posteroinferior labrum injury (posterior Bankart lesion), plaication, 8 and bone-block procedures to repair the bone defect of the humeral head (reverse Hill-Sachs lesion) [11][12][13] or strengthening the subscapularis tendon.…”