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Background
The current study describes several surgical techniques for the treatment of the reverse Hill - Sachs lesion after posterior shoulder dislocation; we also aimed to present long term results followed for a minimum of five years.
Methods
This study is a prospective case series of 17 patients who were treated in our clinic between 2008 and...
Context in source publication
Context 1
... radiological examination in two views is obligatory (anteroposterior (a-p) and axial; Fig. 1). If pain precludes an axial x-ray because of limited abduction, a 'scapular- Y' view is recommended, even if there is marked pain. In the a.-p. view the posterior dislocation classically appears as a 'light-bulb' but this is not diagnostic and dislocation is thus sometimes difficult to detect [9]. Moreover, a careful clinical ...
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Introduction::
Engaging Hill-Sachs lesions in recurrent anterior shoulder dislocation have been managed with the remplissage procedure. Clinical and cadaveric studies have reported limitation of rotation after this procedure. We introduce the reverse McLaughlin procedure where the infraspinatus and the underlying capsule are detached and approxima...
Objective:
To evaluate the results of arthroscopic surgery in patients with traumatic anterior shoulder dislocation.
Methods:
This retrospective study analyzed 76 patients with a mean age of 28 and mean postoperative follow-up period of 62 months. Evaluation consisted of physical examination, and X-rays; results were classified according to the UC...
This chapter discusses humeral avulsions of the glenohumeral ligament (HAGL) lesions, both anterior and posterior. While injuries of the anteroinferior glenoid labrum (Bankart lesions) and of the posteroinferior glenoid labrum (posterior Bankart lesions) are well-recognized, common injuries following traumatic shoulder dislocations and subluxations...
Background
Shoulder dislocation is a common injury, particularly in the younger population. Common long-term sequelae include pain, recurrence, and shoulder arthritis. Immediate and correct diagnosis following shoulder dislocation is key to achieving optimum outcomes. Although magnetic resonance arthrography (MRA) is frequently used for diagnosing...
Background
In adults, anterior glenohumeral instability has been associated with a tall and narrow glenoid morphology, assessed using the glenoid index (GI; glenoid height-to-width ratio) on magnetic resonance imaging (MRI). This morphological association has not been assessed in children and adolescents.
Purpose/Hypothesis
To examine the associat...
Citations
... If the defect is too large or insufficient for disimpaction, an alternative is replacement of the defect with osteochondral autograft or allograft. Several methods have been reported including the use of humeral or femoral head allograft or autologous iliac crest 47,61,62 . After removal of the damaged osteochondral fragment, it can be useful to temporarily use cement to obtain the exact dimensions of the defect, after which the donor graft is replicated to the size of the temporary cement and fixed with screws or pressfit method. ...
» Posterior glenohumeral instability is relatively uncommon compared with anterior instability, but is becoming an increasingly recognized and surgically managed shoulder pathology.
» Soft-tissue stabilization alone may not be sufficient in patients who present with substantial bone loss to the posterior glenoid and/or the anterior humeral head.
» For posterior glenoid defects, posterior glenoid osteoarticular augmentation can be used, and posterior glenoid opening wedge osteotomy can be considered in cases of posterior instability with pathologic retroversion.
» For humeral head lesions, several surgical treatment options are available including subscapularis transposition into the humeral head defect, autograft or allograft reconstruction, humeral rotation osteotomy, and shoulder arthroplasty.
... Kokkalis et al. [30] 84 (77-90) n/a n/a n/a n/a n/a n/a Shams et al. [32] n/a n/a n/a n/a Khira and Salama [29] n/a n/a n/a n/a n/a 30 (28)(29)(30)(31)(32)(33) n/a Cohen et al. [23] 65 ± 21.5 n/a n/a n/a n/a 9.8 ± 1.3 (8-12) 2.4 ± 2.3 n/a n/a n/a n/a n/a Bock et al. [28] 88.2 (83-98) n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 17.2 (6-20) 155 n/a n/a n/a Martinez et al. [26] 77 (52-98) n/a n/a n/a n/a n/a n/a n/a 117.5 ± 40.2 n/a 69.2 ± 17.9 ...
... In particular they reported a case series of five patients treated with retrograde elevation using arthroscopic assistance and a target device from knee ligament surgery, four patients treated with open reduction and antegrade corticocancellous cylindrical grafts and three patients with corticocancellous graft of the iliac crest. In conclusion, they observed best outcomes by using an autologous iliac crest corticocancellous bone graft, due to the lower secondary sintering rate of corticocancellous bone graft compared to retrograde elevation of the articular surface or antegrade cylindrical osteochondral grafting [33]. ...
Purpose
Various surgical treatments have been described for the treatment of reverse Hill–Sachs lesions (rHSls) sized between 20% and 50% in the case of posterior shoulder dislocation. The aim of this systematic review is to report the clinical and radiological outcomes of subscapularis or lesser tuberosity transfer (McLaughlin and modified procedures) compared to bone or osteochondral autograft or allograft.
Methods
A systematic review was performed on five medical databases up to December 2022. The inclusion criteria were clinical studies of all levels of evidence describing clinical or radiological outcomes of either procedure. The assessment of the quality of evidence was performed with the Modified Coleman Score.
Results
A total of 14 studies (five prospective and nine retrospective) were included. A total of 153 patients (155 shoulders, 78.4% male) with a mean age of 37.2 (22–79) years were reviewed at an average follow‐up of 53.1 (7.1–294) months. No relevant difference was found for the clinical scores, range of motion, complications and redislocation rate between the two treatments. Radiological osteoarthritis (OA) was reported in 11% (10/87) in the McLaughlin group and in 21% (16/73) in the humeral reconstruction group.
Conclusions
McLaughlin and anatomic humeral reconstruction lead to similar satisfactory clinical results and a low redislocation rate in the treatment of rHSls. Anatomic humeral reconstruction seems associated with an increased risk of OA progression.
Level of Evidence
Level IV.
... Three studies 25,33,41 reported on disimpaction and fixation of the RHSL with overall 22 patients with a mean age of 46 (Table 2) and mean defect size of 35% (range 19%-45%). Only 1 patient had recurrent instability (5%). ...
... Overall CMS was 88 to 92 (I 2 ¼ 0%), and ROM included abduction of 147 (one study), forward flexion of 158 to 162 (I 2 ¼ 0%) and external rotation of 58 (one study) ( Table 3, and Figs 2, 3, 6, and 7). 23 2019 Eur J Orthop Surg Traumatol IV Case series 2 2 2 2 1 1 2 0 12 Banerjee et al. 24 2013 Knee Surg Sports Traumatol Arthrosc IV Case series 2 2 2 2 1 2 2 0 13 Bock et al. 25 2007 Arch Orthop Trauma Surg IV Case series 1 2 2 2 1 2 2 0 12 Brilakis et al. 26 2019 Joints IV Case series 1 2 2 2 1 2 2 0 12 Castagna et al. 27 2009 Muscoskelet Surg IV Case series 1 1 1 2 1 2 2 0 10 Checchia et al. 28 1998 J Shoulder Elbow Surg III Cohort study 0 1 1 1 0 2 1 0 6 Cheng et al. 29 1997 J Shoulder Elbow Surg IV Case series 1 2 2 2 1 2 2 0 12 Cohen et al. 30 2021 J Shoulder Elbow Surg IV Case series 2 2 2 2 1 2 2 0 13 Demirel et al. 31 2017 Acta Orthop Traumatol Turc IV Case series 2 2 2 2 1 2 2 0 13 Diklic et al. 32 2009 J Bone Joint Surg Br IV Case series 2 2 2 1 1 2 2 0 12 Gerber et al. 19 2014 J Shoulder Elbow Surg IV Case series 1 1 1 2 1 2 1 0 9 Guehring et al. 33 2017 BMC Musculoskelet Disord III Cohort study 2 1 2 2 1 2 2 0 12 Haritinian et al. 34 2023 BMC Musculoskelet Disord IV Case series 2 1 2 2 1 2 2 0 12 Hawkins et al. 35 1987 J Bone Joint Surg Am III Cohort study 2 2 2 1 1 2 2 0 12 Ippolito et al. 36 2021 J Clin Med III Cohort study 2 1 2 2 1 0 1 0 9 Keppler et al. 37 1994 J Orthop Trauma IV Case series 1 1 1 2 1 2 2 1 11 Kokkalis et al. 38 2013 Orthopedics IV Case series 2 2 1 2 1 1 2 0 11 Marcheggiani Muccioli et al. 39 2021 BMC Musculoskelet Disord IV Case series 1 2 2 2 1 2 2 0 12 Martinez et al. 40 2013 Injury IV Case series 2 2 2 2 1 2 2 0 13 Mi et al. 41 2021 Orthop Surg IV Case series 1 2 0 2 0 2 2 0 9 Mittal et al. 42 2022 J Clin Orthop Trauma IV Case series 2 1 2 1 1 2 2 0 11 Romano et al. 43 2020 Knee Surg Sports Traumatol Arthrosc IV Case series 2 2 2 0 2 2 2 1 13 Shams et al. 44 2016 Eur J Orthop Surg Traumatol IV Case series 2 2 2 2 2 1 2 1 14 Surin et al. 45 1990 J Bone Joint Surg Am IV Case series 2 2 2 2 0 2 1 0 11 Xiong et al. 46 2023 BMC Musculoskelet Disord IV Case series 2 2 2 2 0 2 2 0 12 Ziran and Nourbakhsh 47 2015 Patient Saf Surg IV Case series 2 1 1 2 2 2 2 1 13 ...
... Five studies 19,32,33,39,40 reported on the outcomes in 57 patients who underwent autograft or allograft replacement of the RHSL. Mean age was 44 years (range 20-75 years), and mean size of defect was 38% (range 25%-55%). ...
Purpose: The purpose of this study was to systematically review the literature and report the outcomes of various surgical treatments for reverse Hill Sachs lesions (RHSL) in the setting of posterior shoulder instability.
Methods: PRISMA-guidelines were followed. All studies assessing outcomes of surgical treatment of RHSL from inception to January 2023 were identified in PubMed, Embase and Cochrane. Inclusion criteria consisted of studies reporting outcomes, minimum mean 1-year follow-up, minimum level 4 evidence. Outcomes were assessed using Forest plots with random effects models using R software.
Results: A total of 29 studies consisting of 291 patients were included with a mean age of 42 (range 16-88), 87% male gender, and mean follow-up of 4.5 years. The mean size of impacted or affected cartilage was 35% and time from injury to surgery was mean 15 weeks. Nearly all studies were level 4 evidence and quality of studies was low. Random effect models were performed and data was presented as range. Low incidence of instability was noted for all surgical techniques with good PROMs. Most studies reported outcomes of the modified McLaughlin procedure (13 studies, 126 patients) with overall Constant-Murley Score (CMS) of 65-92. Trends were seen towards better CMS and external rotation with a shorter delay between injury, and when arthroscopic and joint preserving treatments were performed.
Conclusion: This systematic review showed low rates of instability recurrence, reproducible ROM and favorable PROMs were reported following all treatments for RHSLs with posterior instability. There was a significant association between better outcomes and a shorter delay between injury and surgery. The level of evidence is limited given the small and retrospective studies which can be explained by the rarity of these injuries.
... A significant percentage (50-79%) of posterior shoulder dislocations are missed on initial presentation [5]. Thorough clinical examination is crucial and usually shows flattening of the anterior shoulder, a prominent coracoid process, severely limited external rotation and reduced abduction [6]. True anteroposterior and axillary Page 2 of 9 Haritinian et al. ...
... The choice of procedure and prognosis depend on the time to surgery, the size of the RHSL and the possible presence of glenohumeral osteoarthritis. Conservative treatment can be effective in promptly diagnosed cases with stable shoulders and minor bone defects (less than 25% of the articular surface) after closed reduction [6]. Locked posterior shoulder dislocations with an RHSL involving 25-40% of the articular surface can be repaired by transposition of the subscapularis muscle (McLaughlin procedure) [14,15], lesser tuberosity transposition (Hawkins et al. 's modified McLaughlin procedure) [15][16][17], a modified McLaughlin procedure augmented with an autograft from the iliac crest [18], reconstruction of the humeral head defect using an allograft [19,20], rotational osteotomy of the humerus [21,22] or posterior bone block [23]. ...
Background
Posterior shoulder dislocations are rare injuries that are often missed on initial presentation. Cases left untreated for more than three weeks are considered chronic, cannot be reduced closely (they become locked) and are usually associated with a significant reverse Hill-Sachs defect. The aim of this study was to evaluate the outcomes of chronic locked posterior shoulder dislocations treated with the McLaughlin procedure (classic or modified).
Methods
This retrospective study included 12 patients with chronic locked posterior shoulder dislocation operated on between 2000 and 2021 by two surgeons in two institutions. Patients received a thorough clinical examination and radiological assessment before and after surgery. Shoulders were repaired with the McLaughlin or modified McLaughlin procedure. Outcomes were assessed by comparing pre- and postoperative values of clinical variables.
Results
Most of the dislocations were of traumatic origin. The average delay between dislocation and surgical reduction was 13.5 ± 9.7 weeks. Postoperative clinical outcomes were favourable, with an average subjective shoulder value of 86.4 ± 11.1 and a normalized Constant –Murley score of 90 ± 8.3. None of the patients had a recurrence of shoulder dislocation, but one patient developed avascular necrosis of the humeral head and two patients developed glenohumeral osteoarthritis.
Conclusions
In this group of patients with chronic locked posterior shoulder dislocation, the clinical outcomes of McLaughlin and modified McLaughlin procedures were satisfactory, even when surgery was significantly delayed.
... [39] The most common indications in the arthroplasty/reversed total arthroplasty group were comminuted fractures (four-part fracturedislocations), impression fractures greater than 45%, advanced patient age, concomitant osteoarthritis, presence of an irreparable rotator cuff tear, and presence of conditions, such as osteogenesis imperfecta. [8,15,16,[19][20][21][22][23][24][25][26][27] Trauma is the most common cause of bilateral locked shoulder dislocation (n=52). Still, considering that, in one article, 26 of 35 patients were traumatic, disregarding this article, the most common cause is epileptic seizure (n=41). ...
... According to the literature review, fresh injuries and intraoperatively reducible fractures (three-part and some simple four-part fractures), particularly those with less than 20% reverse Hill-Sachs lesions, were treated with the method of closed or open reduction and K-wire or internal fixation. [11][12][13][14][15][16] In addition, the literature review revealed that a significant number of neglected (late presenting or overlooked) patients, particularly those with reverse Hill-Sachs lesions between 20 and 45%, were treated with the modified McLaughlin procedure. [1,6,[28][29][30][31][32][33][34]37] Khira and Salama [28] reported the results (n=12) of an open reduction and reconstruction of the humeral head defect using the McLaughlin technique modified by Hawkins et al., [10] in which the insertion of the subscapularis muscle was displaced with lesser tuberosity and augmented with a bone graft from the iliac crest fixed with screws. ...
... Further, Guehring et al. [16] described several surgical techniques for treating reverse Hill-Sachs lesions after posterior shoulder dislocation. The authors described long-term results that were followed for at least five years. ...
A locked posterior shoulder dislocation (LPSD) can present in three forms: fracture-dislocation, impression fracture, and isolated dislocation without fracture. [1] An epileptic seizure causing severe contractions in the body is the most common cause of posterior shoulder dislocation, [2] followed by electrocution and trauma. In addition, LPSD accounts for 2 to 4% of all shoulder dislocations, and the annual incidence is 0.6 per 100,000 individuals. [3] The first posterior dislocation causes an impression fracture (reverse Hill-Sachs lesion) of the anteromedial humeral head in 30 to 90% of cases. [4,5] If the reverse Hill-Sachs lesion accounts for more than 20% of the articular surface of the humeral head, instability may develop during the internal Neglected bilateral posterior shoulder dislocation is a rare injury caused primarily by an epileptic seizure. The injury is usually associated with a reverse Hill-Sachs lesion in the anteromedial aspect of the humeral head. The modified McLaughlin technique may avoid instability and osteoarthritis when 20 to 40% of the articular surface is affected by reverse Hill-Sachs. In this article, we present the clinical results of a case overlooked in the literature for the longest time, i.e., for 15 months. A 46-year-old male patient was receiving treatment for epilepsy for five years. There was no fall or trauma in the four seizures he had during this time. The last seizure was 15 months ago. When the patient presented to our clinic, both shoulders were symmetrically deformed, the anterior shoulder contour disappeared (empty socket sign), and there was a loss of upper contour. The computed tomography (CT) scan revealed a posteriorly locked dislocation with a reverse Hill-Sachs lesion in 32% of the left shoulder and 36% of the right shoulder. We applied the modified McLaughlin procedure to the dominant right shoulder and, two months later, we used it to the left shoulder (with a graft taken from the anterior superior iliac spine). At one-year of follow-up, both shoulders were moderately functional: forward elevation left 70° and right 50°, abduction left 40° and right 60°, and internal rotation: the back of the hand could touch the fifth lumbar vertebra. Meanwhile, the patient did not suffer from recurrent dislocation. The pre-and postoperative Constant-Murley Scores for the right and left shoulder were 30/52 and 11/48, respectively. Although the operational outcomes using the modified McLaughlin technique were not ideal, with no recurrence, the patient seemed to be satisfied with this outcome. In conclusion, in neglected locked shoulder fracture-dislocations, the modified McLaughlin technique is a method that can respond to the pathophysiology by eliminating reverse Hill-Sachs lesion.
... 2 At present, algorithms for posterior instability intervention reflect many of the same principles as anterior instability: consideration of the arc of rotation of the humeral head with respect to the glenoid surface. Therefore, surgical strategies include either optimizing the surface arc of rotation (and, therefore, total arc of stability) by restoration of the humeral head (e.g., osteochondral graft), or restriction of the arc of rotation by constraining the motion of the humeral head relative to the glenoid (e.g., reverse-remplissage). 3 Treatment options for posterior instability with rHSL in the current literature are primarily based on the percentage of humeral bone loss: posterior capsulolabral repairs or plications for <25% bone loss, and iliac crest structural bone grafting or distal tibial allografting, reverse remplissage, balloon humeroplasty, 4 hemiarthroplasty, 5 or a talar osteochondral allograft wedge 6 for patients with 25% to 50% humeral head bone loss. Resurfacing and replacement options should be reserved for the older patients who are less active or have severe arthritis in which >50% of the humeral head articular surface is affected. ...
... The authors determined that rHSL size, depth, and medialization significantly increased with chronicity. These findings were supplemented by Gheuring et al. 3 in their retrospective case series of 17 patients that underwent management for rHSLs, in which the authors found that defect sizes <25% of the humeral articular cartilage could be treated conservatively if stable, while patients with 25-40% and >40% defects were successfully managed with bony augmentation and arthroplasty procedures, respectively. Such findings emphasize the importance of rHSL parameters, including superficial size, depth, and medialization, which should be considered to guide treatment decision making and optimize outcomes in the setting of posterior glenohumeral instability. ...
Reverse Hill-Sachs lesions (rHSLs) after chronic posterior shoulder instability are important to recognize and treat appropriately. Treatment options for posterior instability with rHSL in the current literature are primarily based on percentage of humeral bone loss. In cases of moderate (25% to 50%) anterolateral humeral head bone loss, fresh osteochondral allografts are preferred. Recent literature has indicated that the talus serves as a robust grafting alternative site for the humeral head, as the talar dome shows high congruency and offers variable sizes. The purpose of this Technical Note is, therefore, to describe our technique for talus allograft preparation for the treatment of a large rHSL that highlights precise cutting anatomy, sizing options, and use of orthobiologics to ensure excellent talus union to the native humeral head surface.
... For addressing the defect at the anterior part of the humeral head, a variety of surgical procedures exist: (a) filling the defect by subscapularis tendon transposition [5], (b) medial transposition of the lesser tuberosity [6,7], (c) defect-filling with allograft [8], (d) rotational osteotomy [9], (e) arthroplasty [10,11], and (f) arthroscopic or open elevation and stabilization of the impression fracture [12]. ...
Introduction
Posterior shoulder dislocation in association with reverse Hill–Sachs lesion is a rather rare injury. Few studies reporting results after joint-preserving surgery in these cases are available. This current study presents the clinical outcomes 10 years postoperatively.
Materials and methods
In a prospective case series, we operatively treated 12 consecutive patients (all males) after posterior shoulder dislocation with associated reverse Hill–Sachs lesion using joint-preserving techniques. Patients received surgery in a single center between January 2008 and December 2011. The joint-preserving surgical procedure was chosen depending on the defect size and bone quality. The following outcome-measures were analyzed: Constant-Score, DASH-Score, ROWE-Score, and SF-12. Results 1, 5, and 10 years postoperatively were compared.
Results
Out of 12 patients, ten patients (83.3%) were followed-up with a mean follow-up interval of 10.7 years (range 9.3–12.8). The mean patient age at the time of the last follow-up was 51 years (32–66). The outcome scores at the final follow-up were: Constant 92.5 (range 70.0–100), DASH 3.2 (0.0–10.8), ROWE 91.0 (85.0–100), and SF-12 87.8 (77.5–98.3). Clinical results had improved from 1 to 5 years postoperatively and showed a tendency for even further improvement after 10 years.
Conclusions
Joint-preserving surgical therapy of posterior shoulder dislocation provides excellent results when the morphology of the reverse Hill–Sachs lesion is respected in surgical decision-making.
Trial registration
223/2012BO2, 02 August 2010.
... Nezřídka totiž dochází při primárním vyšetření k přehlédnutí zadní luxace. Uvádí se, že až v 79 % případů není zadní luxace diagnostikována při prvotním ošetření (8). Pacientům se řádného ošetření dostává často až s odstupem několika týdnů (9,11). ...
... FASTIN od firmy Mitek. Pro fixaci malého hrbolu používáme 2 šrouby 3,5 mm, které zavádíme tahově, stejně tak fixujeme kostní štěp, na který následně reinzerujeme šlachu m. subscapularis shodně jako bylo uvedeno výše (obr.[6][7][8][9]. Po fixaci šlachy do kosti zkoušíme stabilitu. ...
PURPOSE OF THE STUDY The purpose of this study is to remind of the specific features of diagnosis and therapy of dorsal dislocations of the glenohumeral joint to prevent frequent neglect or misdiagnosis during primary treatment. Also, we strived to present our experience and outcomes of posterior dislocation treatment by McLaughlin procedure and its modified version. MATERIAL AND METHODS We retrospectively evaluated 7 patients who had been treated at our department in the period 2015-2019 by McLaughlin procedure or its modification. The group consisted of 5 men and 2 women aged 33-79 years. In five patients, the dislocation occurred during an epileptic seizure, in two patients during an accident. The patients were treated by McLaughlin procedure or the Neer modification of McLaughlin procedure. The deltoideopectoral surgical approach was always used. Based on the preoperative planning, we decided, or intraoperatively changed our decision, as to whether mere transposition of the subscapularis is satisfactory or whether transposition of the lesser tuberosity to the defect, a bone graft and arthroplasty are necessary. Postoperatively, the operated limb was fixed for 6 weeks in neutral position, which was followed by rehabilitation. RESULTS We evaluated subjective and objective outcomes of the surgery, the radiological finding and in 2 patients also a control CT scan. The function of the shoulder was assessed using the Constant shoulder score and the OSIS scoring system. The resulting score: the mean OSIS was 55.7 points (92.8%) and the mean Constant score was 86.2 points (86.2%), which we regard as a very good result. All patients consider the surgery successful and are satisfied with the outcome. No patient reported recurrent dislocation. DISCUSSION When treating the posterior dislocation of the shoulder, vital is the shoulder reducibility and also the presence or the size of reverse Hill-Sachs defect. The transfer of the subscapularis tendon can be performed as an open procedure or arthroscopically. Inveterate irreducible posterior dislocation of the shoulder is quite a rare diagnosis, which is why even at our department the McLauglin procedure is performed in the order of units per year only. CONCLUSIONS The surgical solution of inveterate posterior dislocation of the shoulder is hardly ever uncomplicated. The reduction alone is often insufficient and some other way of shoulder stabilisation is necessary, often times addressing the humeral head defect. In our to date experience, the McLaughlin procedure or the Neer s modification is an elegant and safe method to treat posterior dislocation with a humeral head defect. The functional outcomes are very good and enable the patients to reengage in everyday activities. Thanks to this procedure shoulder joint arthroplasty can be avoided in younger patients. Nonetheless, in defects that are greater than 50% of the head the replacement is necessary. Due to frequently associated rotator cuff injuries, the most often procedure indicated by us is the reverse total shoulder replacement. Key words: posterior dislocation of the shoulder, reverse Hill-Sachs defect, McLaughlin procedure, Neer s modification.
... diagnostic trap). Related challenges might partially stem from difficulties encountered during achieving reduction of the humeral head back over the glenoid due to long-standing contracture, fibrosis and adhesions of the surrounding soft tissues [1][2][3][4][5][6][7]. ...
... This might be accomplished via repair/reconstruction of concomitant bony (e.g. reverse Hill-Sachs defect) and soft tissue (reverse Bankart labral detachment) lesions [6,[8][9][10][11][12]. ...
Background
Reconstruction of reverse Hill-Sachs defect using osteo-chondral allograft has the advantages of spherical re-contouring and provision of smooth biological articular surface of the reconstructed humeral head. However, worldwide availability and risk of disease transmission of osteo-chondral allograft remain points of increasing concerns. As an alternative to lacking osteo-chondral allograft, the current technical note describes a reconstructive technique of reverse Hill-Sachs defect using autologous fibular grafting.
Methods
Following open reduction of the dislocated humeral head, reverse Hill-Sachs defect was reconstructed using 3–4 autologous fibular pieces (each is of 10 mm in length) fixed in flush with the articular cartilage using 4-mm cancellous screws. Defect reconstruction was then followed by modified McLaughlin’s transfer and posterior capsulorrhaphy.
Results
Spherical contour of the humeral head and gleno-humeral range of motion were restored. Intra-operative dynamic testing of the reconstruct revealed no residual posterior gleno-humeral instability.
Conclusion
Currently reported technique might offer advantages of graft availability, technical simplicity, familiarity and reproducibility, safety (i.e. no disease transmission) and bone preservation facilitating future revision management (if needed). Nevertheless, long-term outcomes of this technique should be investigated via further cohort clinical studies.
... [14]. On the other hand, Guehring et al. recommended conservative treatment for defect size less than 25%; retrograde chondral elevation, antegrade cylindrical graft or graft of the iliac bone crest with an open approach for defect size 25-40%; and shoulder prosthesis for defect more than 40% [15]. Rouleau et al. suggested rehabilitation protocol after PSD reduction with 20° external rotation-abduction braces for four weeks to aid healing of the posterior capsule. ...
Posterior shoulder dislocation is a unique finding in the orthopedics field. Although it is rarely found, this condition is one that must be considered in the presence of acute shoulder pain. Most clinicians often miss this diagnosis on initial examination; therefore, imaging radiographs are often needed to confirm the diagnosis. Unfortunately, insufficient radiographic assessment can be the greatest pitfall in establishing an accurate diagnosis. Multiple radiographic projections, including anteroposterior view, scapular Y view, and the axillary view, are important to achieve an accurate diagnosis. In this study, we present a middle-aged patient with a pain and trauma history on the shoulder. Anteroposterior radiographic examination revealed an atypical finding. Fortunately, additional radiographic projections were successful in establishing the proper diagnosis of posterior shoulder dislocation. This study also presents a comprehensive review of the keys in the recognition and treatment of the injury.
