Management of Locked Posterior Shoulder Dislocation with Reverse Hill–Sachs Lesions via Anatomical Reconstructions

Abstract

Objective: To evaluate the outcomes of locked posterior shoulder dislocation with reverse Hill-Sachs lesions in patients treated with anatomical reconstructions.Methods: Patients who were treated at our institution between January 2016 and June 2020 were retrospectively reviewed. The demographics of the patients including gender, age, occupation, and dominant arm were recorded. Eleven cases from 10 patients qualified in this study. Nine males and one female were included. The mean age of the patients was 44.8 years (range, 33-54 years). Mechanism of injury, duration between injuries and definitive diagnosis, misdiagnosis, size of humeral head impaction, treatment maneuver, and details of operation performed were reviewed. Plain radiographs and computed tomography (CT) scan were taken to determine the size of defects preoperatively and fracture healing during follow-up. During surgery, the deltopectoral approach was employed. Anatomical reconstruction procedure including reduction, disimpaction, bone grafting, and fixation were sequentially performed. Either cancellous autograft from iliac crest or allograft were used and the fractures were anatomically reduced and stabilized by screws or plates. Visual Analog Scale (VAS) and Constant-Murley score were recorded to determine the functional outcomes preoperatively, at 3 months and 6 months postoperatively, and at the last follow-up. The range of motion in forward flexion was recorded at 6 months follow-up postoperatively.Results: Causes of injuries included epileptic seizure in four cases, fall in three cases, and road traffic accident in three cases. Misdiagnoses occurred in five out of 10 patients. The mean time between injury and definitive treatment among those misdiagnosed was 112 days. The mean size of the impacted reverse Hill-Sachs lesions was 33.95% (range, 19.1%-42.6%). All patients received surgical management with anatomical reconstruction approach, including open reduction, disimpaction, bone grafting, and internal fixation. The mean amount of bleeding during operation was 450 mL. The mean follow-up period was 22.6 months. Fracture healing was observed by 8 weeks in all cases postoperatively and evidence of bone grafting could not be further detected on CT scan at 6 month during follow-up. VAS was significantly lower at the last follow-up (0.68 AE 0.21) in comparison to preoperative scores (4.96 AE 0.97) (P < 0.05). Constant-Murley was improved significantly at the last followup (91.7 AE 8.3) in comparison to that preoperatively (40.6 AE 10.3) (P < 0.05). The mean range of motion in forward flexion was 38.25 AE 9.36 preoperatively and significantly improved to 162.48 AE 12.68 at 6-month follow-up (P < 0.05). Conclusion:The anatomical reconstruction procedure by open reduction and bone augmentation for the treatment of locked posterior shoulder dislocation with reverse Hill-Sachs lesion was promising in both fracture healing and functional outcomes.

McLaughlin technique and humeral grafting provide similar results for treatment of reverse Hill–Sachs lesions: A systematic review

“…Out of these, 61 studies were excluded because they were case reports, technical notes or did not meet the inclusion criteria. Ultimately, 14 studies were included in the review, consisting of nine retrospective [ 7 , 8 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] and five were prospective [ 28 , 29 , 30 , 31 , 32 ]. A summary of the study selection process is reported in the PRISMA diagram (Figure 1 ).…”

“…A summary of the study selection process is reported in the PRISMA diagram (Figure 1 ). Regarding the investigated procedures, seven studies reported the results of McLaughlin procedures and seven reported the results of humeral reconstruction by defect filling with femoral head [ 25 , 31 ] or humeral head [ 8 , 26 ] allograft or iliac crest autograft [ 28 ] or both [ 7 , 27 ]. The evaluation with the mCMS showed an overall poor quality of the included articles with a mean of 67.3 (range 57–82).…”

“…Various clinical scoring systems were used to assess postoperative outcomes, including the Constant and Murley Score (CS) [ 7 , 8 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 31 ], the Western Ontario Shoulder Instability Index Score [ 8 ], the American Shoulder and Elbow Surgeons Shoulder Score [ 8 , 21 , 24 ], the Subjective Shoulder Value [ 7 ], the Simple Shoulder Test Score [ 22 ], the University of California, Los Angeles Shoulder Score [ 23 , 29 ], the Visual Analogue Scale (VAS) for pain [ 23 , 27 ] and range of motion evaluation [ 8 , 21 , 22 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 32 ].…”

Management of Bone Loss in Posterior Glenohumeral Shoulder Instability

“…Guehring et al performed arthroscopic elevation of an impacted lesion, reporting excellent PROMs in 5 patients with minimum 5-year follow-up, with no recurrent instability 61 . Finally, Mi et al reported on an open disimpaction and fixation technique, reporting excellent PROMs and forward elevation in 11 patients at 2-year follow-up 45 . In conclusion, disimpaction and fixation seems to be a viable treatment option for moderate-sized RHSLs with excellent early to midterm postoperative outcomes; however, the strength of these conclusions is limited by the small overall sample sizes available in the literature.…”

“…Bipolar bone loss is also more difficult to treat, and Moroder et al have shown that there is a higher risk of an engaging RHSL for every additional millimeter of posterior glenoid bone loss 22 . Several authors have attempted to develop a treatment algorithm for these injuries according to the literature 43,44 or have described the outcomes of various treatments in their own patients, but no widely accepted consensus has been established to date 45-47 . The most important factor for clinical decision-making is the defect size measured using the best-fit-circle.…”