Promising Mid-Term Outcomes after Humeral Head Preserving Surgery of Posterior Fracture Dislocations of the Proximal Humerus

Abstract

Background: The aim of this study was to evaluate the clinical outcome after humeral head preserving surgical treatment of posterior fracture dislocations of the proximal humerus. Methods: Patients with a posterior fracture dislocation of the proximal humerus that were operatively treated in two level-1 trauma centers within a timeframe of 8 years were identified. With a minimum follow-up of 2 years, patients with humeral head preserving surgical treatment were invited for examination. Results: 19/24 fractures (79.2%; mean age 43 years) were examined with a mean follow-up of 4.1 ± 2.1 years. Of these, 12 fractures were categorized as posteriorly dislocated impression type fractures, and 7 fractures as posteriorly dislocated surgical neck fractures. Most impression type fractures were treated by open reduction, allo- or autograft impaction and screw fixation (n = 11), while most surgical neck fractures were treated with locked plating (n = 6). Patients with impression type fractures showed significantly better ASES scores (p = 0.041), Simple Shoulder Test scores (p = 0.003), Rowe scores (p = 0.013) and WOSI scores (p = 0.023), when compared to posteriorly dislocated surgical neck fractures. Range of motion was good to excellent for both groups with no significant difference. Conclusions: This mid-term follow-up study reports good to very good clinical results for humeral head preserving treatment.

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

“…Various surgical treatments have been described for the management of medium impression fractures, such as medial transposition of the lesser tuberosity [ 6 ], defect‐filling with autograft or allograft [ 7 , 8 ], posterior bone block [ 9 ], derotational osteotomy [ 10 ], retrograde elevation of the impression fracture [ 11 ] and arthroscopic or open remplissage with subscapularis tendon [ 12 , 13 ].…”

All-Arthroscopic Management of Locked Posterior Shoulder Dislocation: Reduction Under Direct Visualization and Treatment of Intra-articular Pathologies

“…Chronic LPSD is a condition where dislocation lasts over 3 weeks after an injury. It includes fracture-dislocation, 4 reverse Hill-Sachs lesion (RHSL), and isolated dislocation. LPSD fracture-dislocation occurs at a rate of 0.6 cases per 100,000 people annually.…”