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

Abstract

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.

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.…”

Rafting technique without bone grafting in reverse Hill-Sachs lesions

“…[15] For these medium sized defects, other surgical options are derotation osteotomy of the humerus and reconstruction of the head with allograft or autograft. [2,16,17] Hemiarthroplasty may be performed for large defects involving more than 50% of the head, while total shoulder arthroplasty may be performed for large defects with glenoid destruction. [18] Subscapularis transfer, tuberculum minus transfer and derotation osteotomy are techniques which deteriorate normal anatomy and biomechanics of the shoulder joint.…”

“…It usually occurs secondary to epileptic seizure and most of them are posterior. [1,2] Posterior shoulder dislocations are frequently associated with an anterior impression fracture of the humeral head. The size of this impression defect, the reverse Hill-Sachs or the McLaughlin lesion designates the treatment.…”

“…[5,7,8] Medium defects involving 20-50% of the humeral head can be treated by non-anatomical reconstructions of filling the defect by the subscapularis tendon (McLaughlin procedure) or the lesser tuberosity. [2,5] Anatomic reconstruction procedures for this size of defects are structural allograft or autograft augmentation of the defect either after elevation of the impressed segment or by filling the defect. [2,9,10] Rafting technique can be defined as the buttressing of a depressed osteochondral fragment with raft of screws or even Kirschner wires.…”

“…[2,5] Anatomic reconstruction procedures for this size of defects are structural allograft or autograft augmentation of the defect either after elevation of the impressed segment or by filling the defect. [2,9,10] Rafting technique can be defined as the buttressing of a depressed osteochondral fragment with raft of screws or even Kirschner wires. [11,12] This technique is described especially for depressed tibial plateau fractures.…”