Posterior shoulder fracture-dislocation: A systematic review of the literature and current aspects of management

Abstract

Purpose Posterior fracture-dislocation of shoulder is an infrequent traumatic event; however, most orthopaedic surgeons may face the challenge of treating it. The aim of this study is to review and summarise systematically the current principles of the management of this complex injury, and create a treatment algorithm. Methods Both PubMed and Scopus Databases were systematically searched for the terms “posterior shoulder fracture-dislocation” or “posterior glenohumeral fracture-dislocation” or “posterior glenoid fracture-dislocation” for articles written in English and published in the last decade. Results A total of 900 articles were identified, of which 13 were retained for analysis. A total of 153 patients (161 shoulders) were identified. These patients were treated either with open reduction and internal fixation, modified McLaughlin procedure, allograft/autograft humeral head reconstruction or shoulder arthroplasty. The mean age was 40.15 years. The mean postoperative Constant score in cases treated by open reduction and internal fixation was 86.45, whereas by bone graft was 84.18. Further, the mean postoperative Constant score was between 79.6 and 67.1 in those that were managed by modified McLaughlin and arthroplasty procedure, respectively. Conclusion The management of posterior shoulder fracture-dislocation may be challenging, and the best surgical option depends on many variables such as the chronicity of the injury, the presence of a fracture at the level of the surgical neck or tuberosities and the extend of the Hill-Sachs lesion if any. A treatment algorithm is proposed, based on the current literature in an effort to create a consensus for these injuries. For the acute shoulder fracture-dislocations, an open reduction should be performed. For the chronic fracture/dislocations in the elderly low-demand patients, conservative treatment should be performed. For the rest of the patients, depending on the severity of the Hill-Sachs lesion different surgical options are available such as the McLaughlin technique, the use of an allograft, osteotomy or arthroplasty.

Abordagem clínica e novas técnicas cirúrgicas para luxação de ombro: revisão de literatura / Clinical approach and new surgical techniques for shoulder displacement: literature review

“…Como os idosos tem taxas de luxação recidivas muito mais baixas, o tratamento recomendado na maioria dos casos é o conservador (KAVAJA et al, 2018;PAPAROIDAMIS et al, 2021).…”

Posterior Shoulder Dislocation with Engaging Reverse Hill–Sachs Lesion: A Retrospective Study of Ten Patients Treated with Arthroscopy or Open Reduction and Stabilization

“…Open reduction is usually performed with an anterior deltopectoral approach, allowing the evaluation of the humeral head fracture that is disengaged from the posterior glenoid edge. When considering the type of injury and the treatment, the possibility of redisplacement, nerve injury, intraoperative fracture, and humeral head replacement during surgery should always be considered [10].…”

Posterior Shoulder Dislocation: A Rare Case Report and Review of the Literature

“…The study recommends performing the axillary view projection because a single AP view alone may lead to a misdiagnosis of the injury [6]. Paparoidamis et al explained that appropriate physical and radiologic examination should be highly focused to confirm the diagnosis, which is frequently missed or delayed in up to 79% of the cases [7].…”