New technique in reconstructing humeral head defect in locked posterior dislocation of the shoulder: a case series of nine patients

Abstract

Locked posterior dislocation of the shoulder is uncommon and frequently missed injury. It accounts for 2-4 % of all shoulder dislocations. It is commonly associated with osseous defects in humeral head articular surface known as reverse Hill-Sachs lesion. Numerous surgical procedures are invented to repair this defect with variable outcomes, but evidence-based management strategies are lacking. Among these procedures are as follows: transfer of lesser tuberosity or subscapularis tendon, rotational osteotomy of humerus, osteochondral grafts. Salvage procedure as hemiarthroplasty or total shoulder arthroplasty used in huge non-constructable defect or very old neglected dislocation. In our case series, we treated nine cases (two females) of locked posterior dislocation of the shoulder with anteromedial humeral head defects ranging between 30 and 50 % of head size. Open reduction of dislocation followed by transfer of the lesser tuberosity together with subscapularis tendon for reconstruction of the humeral head defect. The transfer was fixed with Ethibond suture size 5-0 (Ethicon, Inc. Somerville, NJ). The mean follow-up period was 14.5 months (range 12-25 months). Seven cases had no pain or restriction of activities of daily living. No patient had symptoms of instability of the shoulder. According to UCLA shoulder rating scale, there were three cases rated excellent, four cases rated good, one case rated fair, and one case rated poor. It is concluded that reconstruction of the humeral head defect provides good pain relief, stability, and function for patients with a locked posterior dislocation of the shoulder where the defect involves between 30-50 % of the articular surface circumference. Our technique is simple, cheap, and there is no need for second operation for hardware removal.

Clinical and radiographic outcomes of the modified McLaughlin procedure for locked posterior dislocation of the shoulder: a systematic review

“… Study Outcome Findings Castagna, 2009 6 MRI to evaluate subscapularis tendon and humeral head necrosis No evidence of humeral head necrosis, or detachment or fatty infiltration of the subscapularis muscle in any patient at final follow-up Kokkalis, 2013 21 X-ray to evaluate incorporation of morselized allograft into humeral head defect Complete incorporation of morselized allograft into the humeral head defect in all patients at final follow-up Banerjee, 2013 4 X-ray to evaluate glenohumeral osteoarthritis (Samilson-Prieto) and incorporation of lesser tuberosity Complete integration of the lesser tuberosity into the defect in all patients at final follow-up. No signs of osteoarthritis according to Samilson and Prieto Abdel-Hameed, 2015 1 X-ray to evaluate incorporation of lesser tuberosity Complete integration of the lesser tuberosity into the defect in all patients at an average of 8 weeks Shams, 2016 28 X-ray/CT to evaluate incorporation of lesser tuberosity Complete integration of the lesser tuberosity into the defect in all patients within 8-12 weeks Khira and Salama, 2017 19 CT to evaluate incorporation of lesser tuberosity Complete integration of the lesser tuberosity into the defect in all patients at an average of 12 weeks (range, 10-16) Cohen, 2022 9 X-ray to evaluate glenohumeral osteoarthritis (Samilson-Prieto) Grade 1: 6 patients Grade 2: 2 patients Grade 3: 2 patients CT , computed tomography; MRI , magnetic resonance imaging. …”

“…Nine studies with a total of 97 shoulders (96 patients) met the criteria for inclusion. 1 , 3 , 4 , 6 , 9 , 19 , 21 , 24 , 28 All studies were uncontrolled case series published between 2009 and 2022, with five (56%) being published since 2016. Six studies were retrospective in nature, while three were prospective.…”

“…Mechanism of injury was detailed in seven studies (71 shoulders) and included trauma in 44 patients (62%), a seizure in 22 patients (31%), electrocution in 2 patients (3%), and an unknown mechanism in 3 patients (4%). Seven studies reported on chronic LPDS, 1 , 6 , 9 , 19 , 21 , 24 , 28 one study reported on acute LPDS (defined as diagnosis less than 3 weeks from dislocation), 4 and one study included patients with both acute and chronic LPDS. 3 The mean period of neglect among studies reporting exclusively on chronic LPDS was 8 to 25 weeks.…”

Treatment and outcomes of chronic locked posterior shoulder dislocations: a retrospective case series

“…Posterior shoulder dislocations are associated in 30 to 90% of cases [ 8 ] with an osteochondral impression fracture of the anteromedial part of the humeral head called a reverse Hill-Sachs lesion (RHSL) [ 9 ]; however, the term posterior shoulder fracture- dislocation is usually only used in cases (about one third [ 10 ]) with fractures of the humeral neck or the tuberosities [ 11 ]. Alternatively, Robinson et al [ 12 ] have suggested referring to the latter as "complex" fracture-dislocations, as opposed to "simple" fracture-dislocations involving only an impression fracture (RHSL).…”