Allograft reconstruction of segmental defects of the humeral head associated with posterior dislocations of the shoulder

Martı́nez, Amalia; Calvo, Ángel; Díez-Domingo, Javier; Cuenca, Jorge; Herrera, Antonio; Malillos, M.

doi:10.1016/j.injury.2007.11.017

Cited by 42 publications

(36 citation statements)

References 5 publications

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“…Allograft reconstruction is preferable to arthroplasty in larger defects in relatively younger patients (Table I). [1,[7][8][9][10][11][12][13][14] For patients who have good bone quality of the residual head and an absence of relevant osteoarthrosis, reconstruction with an allograft represents a viable alternative to hemiarthroplasty or total joint arthroplasty for carefully selected larger defects. However, our follow-up time was too short to recommend whether avascular necrosis or graft collapse would develop, since posterior bilateral dislocation was usually experienced by middle-aged active males.…”

Section: Discussionmentioning

confidence: 99%

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One-stage surgical treatment of neglected simultaneous bilateral locked posterior dislocation of shoulder: a case report and literature review

Elmalı

Taşdemir

Sağlam

et al. 2015

Eklem Hastalik Cerrahisi

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Bilateral posterior or anterior dislocations of the shoulder joint are rare. [1,2] Most posterior shoulder dislocations have been attributed to high energy trauma, seizures or electroconvulsive therapy. [3] Misdiagnosis of this injury may occur in 50% to 79% of patients, most commonly due to lack of clear clinical signs and accurate imaging study findings. [4,5] Computed tomography can quantify the involvement of the articular surface of the humeral head and identify fractures of the tuberosity, surgical neck, or glenoid. In addition, magnetic resonance imaging has been widely used to reveal posterior cuff tears and posterior avulsion lesions.[6] Treatment of neglected posterior dislocation of the shoulder is challenging.This report describes successful treatment of a simultaneous locked bilateral posterior dislocation of the shoulder with an associated large impression fracture of both articular surfaces of the humeral head due to an epileptic seizure. Defect of the humeral head on right side which was more than 40% of the articular surface was treated with osteochondral allograft femoral head, while a lesser articular defect was treated with the modified McLaughlin technique using absorbable suture anchors in the left side in a one-stage operation. ÖZİki taraflı eş zamanlı kilitli arkaya omuz çıkığı oldukça nadirdir. Bu yazıda grand mal tipi epilepsi nöbetinden sonra her iki humerus başının anteromedial yüzeyinde büyük impresyon kırığı ile birlikte redükte edilemeyen iki taraflı arkaya kilitli omuz çıkığı gelişen 59 yaşında erkek bir olgu sunuldu. Direkt grafiler ve bilgisayarlı tomografide sağ tarafta artiküler yüzeyin %40'ından fazla, sol tarafta %30 oranında defekt saptandı. Hastaya tek seansta sağ tarafına femur başı osteokondral allogrefti ile ve kendisine tutunan subskapularis tendon ile birlikte osteotomize edilen tüberkulum minus'un defekt içerisine transferi (modifiye McLaughlin tekniği) uygulandı. On dört aylık izlemde hasta ağrısız, omuz eklemi stabil ve fonksiyonları tatminkar idi.Anahtar sözcükler: İki taraflı omuz çıkığı; kilitli çıkık; tedavi. ABSTRACTSimultaneous bilateral locked posterior dislocation of the shoulder is a rare injury. Herein, we present a 59-year-old male case with a three-month history of an irreducible locked bilateral posterior dislocation of the shoulders with an associated large impression fracture on the anteromedial aspect of both humeral heads after a grand mal type epileptic seizure. Plain X-ray and computed tomograph revealed a defect on the right side more than 40% of the articular surface, and on the left side, 30%. He was treated with a one-stage operation with a reconstruction of femoral head osteochondral allograft on the right side and transfer of the osteotomized tuberculum minus with its attached subscapularis tendon into the defect (modified McLaughlin technique) on the left side. At 14 months during follow-up, the patient was pain-free with stable shoulder joints and satisfactory functionality.

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Section: Discussionmentioning

confidence: 99%

“…In conclusion, we suggest that hemior total arthroplasty should be reserved the final treatment of choice. [11] Ivkovic et al [2] Gerber et al [12] Kokkalis et al [9] Martínez et al [14] Torrens et al [1] Aparicio et al [6] Hawkins et al [7] Number of cases Clinical and radiological results, excellent.…”

Section: Discussionmentioning

confidence: 99%

One-stage surgical treatment of neglected simultaneous bilateral locked posterior dislocation of shoulder: a case report and literature review

Elmalı

Taşdemir

Sağlam

et al. 2015

Eklem Hastalik Cerrahisi

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“…Moreover, the defect can become more extended, provoking instability, osteoporosis and osteoarthritis [1,8]. Thus, apart from the extent of the humeral head injury and the age of the patient, the choice of treatment also depends on the interval between injury and diagnosis [8,19].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, in spite of the risk associated with a long diagnostic delay and the large size of the defect, this is what we decided on. Even if the procedure would fail, prosthetic reconstruction should be simple because the skeletal anatomy is not distorted [1,5,8,13].…”

Section: Discussionmentioning

confidence: 99%

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Allograft Reconstruction for Reverse Hill-Sachs Lesion in Chronic Locked Posterior Shoulder Dislocation: A Case Report

Scheffer

2012

J Med Cases

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Posterior dislocations of the humeral head are rare and often missed on initial presentation. Half of these injuries are associated with an impression fracture of the anteromedial aspect of the humeral head (reverse Hill-Sachs lesion). Several operative strategies have been described to treat this injury, but evidence based management strategies are lacking. We describe a case in which a young and active patient presented with a stiff and painful shoulder following a clavicle fracture 9 months earlier. MRI revealed a locked posterior shoulder dislocation and large reverse Hill-Sachs defect. Anatomic reconstruction of the humeral head was performed using a femoral head allograft to fill the defect. A year later the patient has a good shoulder function without pain or impairments in his daily activities. Posterior shoulder dislocation continues to be a "diagnostic trap". This case reinforces the importance of radiographic axial and transscapular (Y) shoulder views to prevent missing the diagnosis. We state that, even in cases with delayed diagnosis and large humeral head defects, one should attempt to preserve the stability and function of the shoulder joint by restoring the normal anatomy of the humeral head. Femoral head allografting proves to be a suitable option. This case is unique in the combination of injuries, the long diagnostic delay and the encouraging functional results after femoral head allografting.

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Bone loss in patients with posterior gleno-humeral instability: a systematic review

Longo

Rizzello

Locher

et al. 2014

Knee Surg Sports Traumatol Arthrosc

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Allograft reconstruction of segmental defects of the humeral head associated with posterior dislocations of the shoulder

Cited by 42 publications

References 5 publications

One-stage surgical treatment of neglected simultaneous bilateral locked posterior dislocation of shoulder: a case report and literature review

One-stage surgical treatment of neglected simultaneous bilateral locked posterior dislocation of shoulder: a case report and literature review

Allograft Reconstruction for Reverse Hill-Sachs Lesion in Chronic Locked Posterior Shoulder Dislocation: A Case Report

Bone loss in patients with posterior gleno-humeral instability: a systematic review

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