Modified McLaughlin Technique for Neglected Locked Posterior Dislocation of the Shoulder

Abstract

Several surgical techniques have been described for the treatment of posterior shoulder dislocation depending on the time elapsed between injury and surgery and the size of the humeral head impression fracture. When the bone defect is between 25% and 50% of the articular surface of the head, the procedures of choice are autologous bone graft or allograft or subscapularis tendon or lesser tuberosity transfer. In neglected cases in which patients undergo surgery more than 3 weeks after injury, no standard accepted treatment for this injury exists. This article presents a modification of the McLaughlin technique for patients with neglected locked posterior dislocation of the shoulder. Using this technique, the shape of the humeral head was nearly restored with impaction of morselized bone allograft; two suture anchors were inserted into the defect, and the lesser tuberosity with the attached sub-scapularis tendon was transferred into the defect and secured with sutures. Postoperative rehabilitation included immobilization of the shoulder with an external rotation brace for 6 weeks followed by progressive passive, active-assisted, and active range of motion and rotator cuff strengthening exercises for another 6 weeks. This technique resulted in pain-free range of motion, a stable shoulder, and good joint congruency.

Surgical and Rehabilitative Treatment of Misdiagnosed Posterior Dislocation of the Shoulder: Case Series

“…While our study has the major limit of a small sample, we could assume that our excellent results depend on an early diagnosis. Other series reported in the literature showed how a posterior GHJ dislocation with an associated bone fracture [32], or a reverse Hill-Sachs lesion lower than 50% [33], could be treated with a treatment within 5 months. However, there is also evidence of good results with a later diagnosis with a great functional improvement.…”

Luxación posterior inveterada de hombro asociada a lesión de Hill-Sachs reversa tratada con modificación de la técnica de McLaughlin

“…En el caso descrito, existe compromiso de menos de 50% de la superficie articular de la cabeza humeral, por lo que se prefirió la transferencia de inserción del tendón subescapular sobre el sitio de lesión. 5 De acuerdo a la escala de Constant Score, los resultados funcionales obtenidos son comparables a los reportados en la literatura por Kokkalis y colaboradores, 6 quienes describieron el tratamiento de seis hombros con técnica modificada de McLaughlin con resultados funcionales, con un puntaje de 84 y un restablecimiento casi completo de los arcos de movilidad del hombro; esta serie empleó la modificación de Neer. Los resultados funcionales finales aquí presentados no se vieron afectados por la modificación del método de inserción del tendón en la cabeza humeral y el inicio temprano de los movimientos pasivos en este paciente.…”

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.…”