Bilateral Neglected Posterior Fracture–Dislocation of the Shoulders

Abstract

Posterior dislocation of the shoulder is an uncommon injury. Diagnosis is difficult and often missed. Once diagnosed, management must be individualized depending on the amount of the defect of the humeral head and the time from injury. This article presents a case of a 40-year-old man with a 4-month history of bilateral locked posterior fracture-dislocation of the shoulders after a grand mal seizure. Imaging showed loss of the glenohumeral joint lines congruency, reverse Hill-Sachs lesions, and articular defects of 35% and 40% of the humeral heads. A modified McLaughlin technique was performed in both shoulders in a single stage. Through the standard deltopectoral approach, the lesser tuberosity was osteotomized with the subscapularis and capsule attached and elevated to expose the humeral head and glenoid. The shape of the humeral head was restored by packing the defect with morselized bone allograft. Before packing the allograft into the defect, 2 absorbable suture anchors were inserted at the bottom of the defect; the lesser tuberosity was transferred into the defect, and fixed with 2 transosseous horizontal mattress sutures. Stable fixation was evaluated intraoperatively, and the wound was closed in layers. Postoperatively, both shoulders were immobilized with external rotation braces for 6 weeks, followed by passive, active-assisted, and progressively active range of shoulder motion and rotator cuff strengthening exercises for the next 6 weeks. At 12 weeks postoperatively, full range of motion was accomplished, and full activity was allowed. At 22-month follow-up, the patient was satisfied with his level of function; both shoulder joints were painless and stable without apprehension or recurrence of instability. Radiographs showed congruent joints and complete incorporation of the allograft into the defect with restoration of the shape of the humeral head.

Neglected posterior dislocation of the shoulder: A systematic literature review

“…[51] 2012 1 45 M Seizures Bil 3 AP Kokkalis et al. [55] 2012 1 40 M Seizures Bil 4 AP AP = anteroposterior radiograph; F = female; M = male. …”

Transfer of the lesser tuberosity for reverse Hill-Sachs lesions after neglected posterior dislocations of the shoulder: A retrospective clinical study of 13 cases

“…Although the literature contains many case reports dealing with the neglected posterior shoulder dislocation, 9 , 11 , 14 , 15 , 16 only a limited number of case series are available that report on the transfer of the lesser tuberosity. 1 , 12 , 17 In the study by Hawkins et al, satisfactory outcomes were reported in 4 patients with a mean follow-up of 5.5 years.…”

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

“…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.…”

“…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.…”