Neglected anterior dislocation of shoulder with large Hillsach's lesion & deficient glenoid: Treated by autogenous bone graft & modified Latarjet procedure

Abstract

Neglected anterior dislocation of shoulder is rare in spite of the fact that the anterior dislocation of the shoulder is seen in around 90% of the acute cases. Most of the series of neglected dislocation describe posterior dislocation to be far more common.(1) (,2) We hereby report a case of the neglected anterior shoulder dislocation in a 15 year old boy who had a history of epilepsy. There was a large Hill Sachs lesion in humeral head which was impacted in glenoid inferiorly and glenoid was eburnated at that margin. The humeral head was reconstructed with a tricortical iliac graft. Glenoid was reconstructed by transfer of coracoids process of scapula to antero-inferior glenoid (modified Latarjet procedure). This case is unique because management of humeral head defect with bone graft is not mentioned in anterior dislocation.

A case report of ten-month-neglected anterior shoulder dislocation managed by open reduction combined with Latarjet procedure

“…A traumatic event could lead to anterior shoulder dislocation when it was happened in abducted and extended arm position so greater tuberosity abuts against acromion, causing leverage forces leading humeral head to come out of glenoid cavity [2]. The term of chronic dislocation of the shoulder is applied to condition where there is loss of recognition of injury for at least 3 or 4 weeks, although other authors have described chronic dislocation with various duration [1,5,6]…”

“…Therefore, it requires an extensive surgical procedure [5,6]. A neglected shoulder dislocation, especially with significant bony defects, is a dilemmatic condition since it cannot be managed by standard surgical procedure and concomitant lesions are common, including Hill-Sachs and Bankart lesions, massive glenoid bone loss, rotator cuff tear; and later severe glenohumeral osteoarthritis could also occur [5,6]. Because of severe soft-tissue contracture and imbalance as well as bone deficiency, neglected anterior shoulder dislocation is a difficult problem for both patients and clinicians.…”

“…The outcomes of some procedures, such as Bankart repair, remplissage, coracoid transfer, bone-grafting and arthroplasty, in restoring the stability of the shoulder were varied and the overall failure rates were quite high [2,11,12]. The choice of treatment included observation, manipulation, open reduction with or without allograft reconstruction, Bankarts repair, capsulolabrial repair and arthroplasty [1,5,6]. Surgical treatment for chronic shoulder dislocation is usually advocated for better functional outcome, although the results may be poor and unsatisfactory [2,8].…”

“…A neglected shoulder dislocation is rare and may be accompanied by pathological changes in bony and soft tissue structures. Therefore, it requires extensive surgical procedure [5,6]. Until now, there is no standard treatment for this case and it is a difficult problem for both patients and clinicians.…”

Arthroscopic Remplissage and Open Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Severe Bipolar Bone Loss

“…11,13 Similar to the presented surgical technique of a Latarjet procedure combined with a Hill-Sachs remplissage, the level of evidence regarding dual bone grafting for BBL in AGI is limited to case reports. 14 Potential advantages of the combination of a Latarjet procedure and a Hill-Sachs remplissage include the minimally invasive approach as compared with open dual grafting techniques and the reduced risk of graft resorption or necrosis (Table 2). A potential disadvantage may be a reduced range of glenohumeral rotation after the remplissage.…”