Weber Osteotomy for Large Hill-Sachs Defects: Clinical and CT Assessments

Brooks-Hill, Alexandra L.; Forster, Bruce B.; Wyngaarden, Case Van; Hawkins, Robert J.; Regan, William D.

doi:10.1007/s11999-013-3024-5

Cited by 26 publications

(18 citation statements)

References 23 publications

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“…This technique consists of transecting the proximal humerus transversely at the surgical neck and retroverting the humeral head with relative to the humeral shaft, with the objective being to theoretically achieve derotation of the humeral head, thus preventing reengagement of the lesion. However, this procedure is uncommon given the variability in the derotation achieved and its reportedly high complication rate [76].…”

Section: Weber Osteotomymentioning

confidence: 99%

Understanding the Hill-Sachs Lesion in Its Role in Patients with Recurrent Anterior Shoulder Instability

Fox

Sanchez

Zajac

et al. 2017

Curr Rev Musculoskelet Med

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The most recent literature covering the Hill-Sachs lesion has focused on the relatively new and unexplored topic of the importance of concomitant injuries while treating a humeral head defect. The glenoid track concept has been clinically validated as a method to predict engagement. 3D-CT has become the "gold standard" for Hill-Sachs imaging; however, it has been noted that 3D-MRI produces results that are not significantly different from CT. Also, it has been found that when the arm is in a position of abduction during the primary injury, there is a higher risk of engagement and subsequent dislocation. Recent studies have demonstrated successful results stemming from purely arthroscopic procedures in treating Hill-Sachs lesions. Anterior shoulder instability, specifically the Hill-Sachs lesion, is an area of orthopedic study that is highly active and constantly producing new studies in an attempt of gaining the best outcomes for patients. The past few years have yielded many excellent discoveries, but there is still much more work to be done in order to fully understand the role of the Hill-Sachs lesion in anterior shoulder instability.

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Section: Weber Osteotomymentioning

confidence: 99%

Understanding the Hill-Sachs Lesion in Its Role in Patients with Recurrent Anterior Shoulder Instability

Fox

Sanchez

Zajac

et al. 2017

Curr Rev Musculoskelet Med

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“…However, very large defects can engage the anterior rim of the glenoid when the arm is in ABER position and cause instability even after glenoid repair (42)(43)(44). Accordingly, mention of clinically important osseous deficiency in imaging reports is essential given the high failure rate of arthroscopic Bankart repairs with such large engaging Hill-Sachs deformities and the albeit uncommon subsequent indication for open surgery to repair the defect (44,45).…”

Section: Figurementioning

confidence: 99%

Beyond the Cuff: MR Imaging of Labroligamentous Injuries in the Athletic Shoulder

Roy¹,

Cheyne²,

Andrews³

et al. 2016

Radiology

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Shoulder disease is common in the athletic population and may arise as a consequence of a single traumatic episode or multiple repeated events. Associated labroligamentous injuries can result in substantial disability. Specific athletic and occupational activities result in predictable injury patterns. Imaging in general and magnetic resonance (MR) imaging, in particular, are vital in establishing the correct diagnosis and excluding common mimicking conditions, to ensure timely and appropriate management. In this review, the utility of MR imaging and MR arthrography will be explored in evaluation of shoulder disease, taking into account normal variants of the labroligamentous complex. Subsequently, broad categories of labral lesions and instability, external and internal impingement, as well as nerve entrapment syndromes, will be discussed, while emphasizing their imaging findings in the clinical context and illustrating key features. More recent concepts of internal impingement and secondary subacromial impingement will also be clarified.

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“…Humeral osteotomy was first described by Weber and consists in a rotational osteotomy of the proximal humeral shaft in order to improve retroversion of the proximal humerus [ 53 ]. It involves a subcapital humeral osteotomy with a medial rotation of the humeral head and imbrication of the subscapularis and anterior capsule [ 54 ]. The main retroversion aimed is 20º to 35º and the use of a guide intraoperatively is recommended to confirm the amount of derotation before plating, as it is a technically highly demanding procedure [ 55 , 56 ].…”

Section: Humeral Osteotomymentioning

confidence: 99%

“…In the clinical scenario of a young patient with a massive Hill Sachs and early degenerative changes, there are not satisfactory options. More conservative options would include partial and complete resurfacing [ 54 ]. When comparing partial resurfacing with graft implantation, it is not clear whether it is easier to match the defect with the implant or with the bone plug, as the geometry might be difficult to reproduce [ 57 ].…”

Section: Resurfacing and Hemiarthroplastymentioning

confidence: 99%

“…When comparing partial resurfacing with graft implantation, it is not clear whether it is easier to match the defect with the implant or with the bone plug, as the geometry might be difficult to reproduce [ 57 ]. With regards to complete resurfacing and arthroplasty, it might be indicated in the setting of chronic dislocations with Hill Sachs defects greater than 40% [ 36 , 54 ].…”

Section: Resurfacing and Hemiarthroplastymentioning

confidence: 99%

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Management of Humeral Defects in Anterior Shoulder Instability

Mora¹,

Ibán²,

Heredia³

et al. 2017

Open Orthopaed. J.

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Background:A Hill Sachs lesion is a posterior-superior bony defect of the humeral head caused by a compression of the hard glenoid rim against the soft cancellous bone in the context of an anterior instability episode. The presence of these humeral defects increases with the number of dislocations and larger lesions are associated with a greater chance of development of recurrent instability and recurrence after surgery. Also its location and pattern, in particular the so-called engaging Hill-Sachs, are associated with poor prognosis.Methods:There is a lack of consensus in terms of classification and management algorithm, although lesions greater than 25% of the humeral head had been suggested to need more than a simple Bankart repair to avoid recurrence. The concept of glenoid track has turned the attention to location and shape and not only size of the humeral defect. Moreover, the glenoid bone loss is crucial when choosing a treatment option as it contributes to decrease the glenoid track as well. A thorough revision of treatment options has been performed.Results:Numerous treatment options have been proposed including remplissage, glenoid or humeral head augmentation, bone desimpaction, humeral rotational osteotomy and arthroplasty.Conclusion:Humeral defects treatment should be individualized. Determination of size and location of the defect and its relation with glenoid track is mandatory to achieve satisfactory results.

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Weber Osteotomy for Large Hill-Sachs Defects: Clinical and CT Assessments

Cited by 26 publications

References 23 publications

Understanding the Hill-Sachs Lesion in Its Role in Patients with Recurrent Anterior Shoulder Instability

Understanding the Hill-Sachs Lesion in Its Role in Patients with Recurrent Anterior Shoulder Instability

Beyond the Cuff: MR Imaging of Labroligamentous Injuries in the Athletic Shoulder

Management of Humeral Defects in Anterior Shoulder Instability

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