Traumatic posterior shoulder dislocation: a case with modification of Gerber procedure for humeral head reconstruction at 10-year follow-up

Objective. To describe a new radiographic sign, “veil of obscuration”, associated with posterior glenohumeral joint (shoulder) dislocations and determine its incidence and validity compared to other known classic radiographic signs.Methods. Four-year retrospective study identified 30 acute posterior shoulder dislocation patients. Radiographs reviewed in consensus by 2 musculoskeletal radiologists for the “veil of obscuration”, seen on AP shoulder radiographs and representing a comminuted fracture of the lesser tuberosity projecting over the humeral head or glenohumeral joint. Incidence of this radiographic sign of posterior glenohumeral joint dislocation in addition to other previously described classic radiographic signs, and association with other fractures, surgery, and mechanism of injury were evaluated. Continuous data was analysed with student t-test and categorical data with Chi-Square test.Results. There were 20 right and 10 left posterior shoulder dislocations. Majority of injuries resulted from vehicle crash (44%). In most cases, reverse Hill-Sachs lesion (83%) and fixed internal rotation of the humeral head (76%) were present, followed by trough line (43%) and “veil of obscuration” (40%). Trough line was seen in significantly more major trauma and vehicle crashes (78% and 46%; P=0.015), while “veil of obscuration” was seen in more seizures (86%; P=0.037) and in all surgical patients. No significant difference in presence of other classic radiographic signs in regards to surgery.Conclusion. The newly described radiographic sign of posterior shoulder dislocations named the “veil of obscuration” has comparable incidence as other classic radiographic signs and may be useful in the recognition and diagnosis of these injuries.

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Treatment and Follow-Up of a Locked Posterior Shoulder Dislocation

European Journal of Trauma ◽

10.1007/s00068-004-1326-8 ◽

2004 ◽

Vol 30 (1) ◽

pp. 47-50 ◽

Cited By ~ 1

Author(s):

Hagen Schmal ◽

Christof Klemt ◽

Norbert P. S�dkamp

Keyword(s):

Shoulder Dislocation ◽

Posterior Shoulder Dislocation ◽

Locked Posterior Shoulder Dislocation ◽

Posterior Shoulder

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Mid-Term outcomes following fresh-frozen humeral head osteochondral allograft reconstruction for reverse Hill Sachs lesion: a case series

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04657-z ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Giulio Maria Marcheggiani Muccioli ◽

Vito Gaetano Rinaldi ◽

Giada Lullini ◽

Alice Ritali ◽

Massimiliano Mosca ◽

...

Keyword(s):

Humeral Head ◽

Shoulder Dislocation ◽

Case Series ◽

Posterior Shoulder Dislocation ◽

Link Type ◽

Locked Posterior Shoulder Dislocation ◽

Posterior Shoulder ◽

Fresh Frozen ◽

The Mean ◽

Osteochondral Allografts

Abstract Background Locked posterior glenohumeral dislocations with a reverse Hill-Sachs impaction fracture involving less than 30% of the humeral head are most frequently treated with lesser tuberosity transfer into the defect, whereas those involving more than 50% undergo humeral head arthroplasty. Reconstruction of the defect with segmental femoral osteochondral allografts has been proposed to treat patients between these two ranges, but the medium−/long-term outcomes of this joint-preserving procedure are controversial. Methods Between 2001 and 2018, 12 consecutive patients with a unilateral locked posterior shoulder dislocation and an impaction fracture from 30 to 50% (mean 31% ± 1.32) of the humeral head were treated with segmental reconstruction of the defect with fresh-frozen humeral head osteochondral allografts. Patients were assessed clinically, radiographically and with computed tomography (CT) at a medium follow-up of 66 ± 50.25 months (range, 24–225). Results All twelve shoulders presented a slight limitation in anterior elevation (average, 166.6° ± 22.76). The mean active external rotation with the shoulder at 90° of abduction was 82.5° ± 6.61, and that with the arm held in stable adduction was 79.16 ± 18.80. The mean abduction was 156.25° ± 25.09. The mean Constant-Murley score (CS) was 82 ± 15.09 points (range, 40–97 points), and the mean ASES was 94 ± 8.49 points. The mean pre- and postoperatively Western Ontario Shoulder Instability index (WOSI) was 236.5 ± 227.9 and 11.20 ± 10.85, respectively. Development of osteoarthrosis (OA) was minimal. The average allograft resorption rate was 4% ± 2.4. There were no cases of failure (reoperation for any reason) in this series. Conclusion Segmental humeral head reconstruction with humeral head fresh-frozen osteochondral allografts provides good to excellent clinical results with low-grade OA and low allograft resorption in patients with locked posterior shoulder dislocation. Trial registration ClinicalTrials.gov PRS, ClinicalTrials.gov ID: NCT04823455. Registered 29 March 2021 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AU8P&selectaction=Edit&uid=U0004J36&ts=12&cx=6cykp8 Level of evidence Level IV, Case Series, Treatment Study.

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All-Arthroscopic McLaughlin's Procedure in Patients with Reverse Hill–Sachs Lesion Caused by Locked Posterior Shoulder Dislocation

Joints ◽

10.1055/s-0039-3401820 ◽

2019 ◽

Author(s):

Emmanouil Brilakis ◽

Michael-Alexander Malahias ◽

Maria Patramani ◽

Grigoris Avramidis ◽

Dimitrios Gerogiannis ◽

...

Keyword(s):

Shoulder Dislocation ◽

External Rotation ◽

The Body ◽

Posterior Shoulder Dislocation ◽

Locked Posterior Shoulder Dislocation ◽

Posterior Shoulder ◽

Retrospective Clinical Study ◽

Clinical Series ◽

Mclaughlin Procedure

Abstract Purpose This study aims to investigate the clinical and functional outcomes of the all-arthroscopic McLaughlin procedure in a clinical series of patients suffering by neglected locked posterior shoulder dislocation. Methods A retrospective clinical study based on prospectively collected data was conducted in a single center regarding 10 patients with neglected locked posterior shoulder dislocation and concomitant reverse Hill–Sachs lesion, who were treated with the all-arthroscopic Mclaughlin procedure. The average humeral bone defect was 39 ± 7% according to the preoperative computed tomography evaluation. The mean time of follow-up was 77 ± 16 months (range, 63–104 months). Results No patient had suffered a new dislocation, whereas all of them were satisfied with the surgical outcome and returned to their previous activities of daily living. External rotation was restored to every patient studied from 0 degrees at the baseline. At the last follow-up, the median external rotation beside the body was 90 degrees (range, 50–90 degrees; p < 0.01) and the respective measurement at 90 degrees of abduction was 90 degrees (range, 80–90 degrees; p < 0.01). The active forward flexion was increased (p < 0.01), from 60 degrees (range, 30–180 degrees) at the baseline to 180 degrees (range, 160–180 degrees) at the last follow-up and the internal rotation was gained (p < 0.01) from the level of buttock (range, lateral thigh–T12) at the baseline to the T11 level (range, T7–L3) at the last follow-up. The median UCLA score was increased from 8 (range, 4–22) to 35 (range, 33–35; p < 0.01) and the Oxford instability score from 5 (range, 3–16) to 46 (range, 43–48; p < 0.01), respectively. Conclusion The arthroscopic McLaughlin procedure in substantial reverse Hills–Sachs lesion caused by locked posterior dislocation leads to excellent clinical and functional results in the long-term follow-up. Level of Evidence This is a therapeutic study, case series with no comparison group, Level IV.

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Reconstruction of the articular surface of the humeral head after locked posterior shoulder dislocation: a case report

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-008-0762-z ◽

2008 ◽

Vol 129 (4) ◽

pp. 515-519 ◽

Cited By ~ 19

Author(s):

T. Khayal ◽

M. Wild ◽

J. Windolf

Keyword(s):

Case Report ◽

Humeral Head ◽

Shoulder Dislocation ◽

Articular Surface ◽

Posterior Shoulder Dislocation ◽

Locked Posterior Shoulder Dislocation ◽

Posterior Shoulder

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Joint Preserving Treatment of Chronic Locked Posterior Shoulder Dislocation by Means of Combined Humeral Allograft Reconstruction and Posterior Glenoid Autograft Augmentation

Zeitschrift für Orthopädie und Unfallchirurgie ◽

10.1055/a-1651-0943 ◽

2021 ◽

Author(s):

Katja Rüttershoff ◽

Doruk Akgün ◽

Philipp Moroder

Keyword(s):

Shoulder Arthroplasty ◽

Humeral Head ◽

Shoulder Dislocation ◽

Iliac Crest ◽

Young Patients ◽

Posterior Shoulder Dislocation ◽

Allograft Reconstruction ◽

Locked Posterior Shoulder Dislocation ◽

Posterior Shoulder ◽

Fresh Frozen

AbstractChronic locked posterior shoulder dislocations are challenging to treat and often warrant total shoulder arthroplasty. While joint preserving treatment is preferable in young patients, surgical techniques to treat this pathology have rarely been described in the literature. This technical note presents the treatment of a 30-year-old male patient with a chronic locked posterior shoulder dislocation by means of combined humeral allograft reconstruction and posterior glenoid autograft augmentation. Restoration of the spheric humeral head surface was obtained using a fresh-frozen femoral allograft fixed with two reabsorbable screws. Due to the intraoperatively persistent posterior instability after humeral reconstruction, the posterior glenoid was augmented with a tricortical iliac crest autograft, which was fixed with two metal screws. This treatment strategy resulted in a full range of motion and a centered stable shoulder joint at one-year follow-up. Therefore, the procedure of segmental reconstruction of the humeral head with a fresh-frozen allograft combined with a posterior glenoid augmentation with an iliac crest bone autograft is a joint-preserving treatment alternative to shoulder arthroplasty in young patients when humeral head reconstruction alone does not suffice.

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Acute Posterior Shoulder Dislocation with Reverse Hill-Sachs Lesion of the Epiphyseal Humeral Head

ISRN Surgery ◽

10.5402/2011/851051 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 11

Author(s):

Luigi Patrizio ◽

Ettore Sabetta

Keyword(s):

Activities Of Daily Living ◽

Humeral Head ◽

Shoulder Dislocation ◽

Daily Living ◽

Articular Surface ◽

Left Shoulder ◽

Posterior Shoulder Dislocation ◽

Lesser Tuberosity ◽

Direct Trauma ◽

Posterior Shoulder

Posterior dislocation of the shoulder is an unfrequent event that often occurs as a consequence of a direct trauma or epileptic crisis. Frequently the posterior dislocations are misunderstood, so they become chronic lesions. We reported a case of an acute posterior left shoulder dislocation with lesser tuberosity fracture and reverse Hill-Sachs lesions which involved more than 25% of the articular surface of the humeral head, in a 57-old-year man with right hemiparesis. We performed a synthesis of the lesser tuberosity with a screw, and we restored the shape of the humeral head with allograft. We achieved a good result that allows the patient to be able to do his previous activities of daily living.

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A Modified Reverse Remplissage Procedure for Management of a Locked Posterior Shoulder Dislocation

Case Reports in Orthopedics ◽

10.1155/2020/8625368 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Xavier Zwiebel ◽

Stéphane Pelet ◽

Alexandre Leclerc

Keyword(s):

Surgical Management ◽

Humeral Head ◽

Shoulder Dislocation ◽

Open Reduction ◽

Posterior Dislocation ◽

Subscapularis Tendon ◽

Functional Level ◽

Posterior Shoulder Dislocation ◽

Locked Posterior Shoulder Dislocation ◽

Posterior Shoulder

Posterior shoulder dislocation is rare and often represents a diagnostic and therapeutic challenge. An impaction fracture of the anteroinferior aspect of the humeral head (called a reverse Hill-Sachs (RHS) fracture) is always present in case of chronic locked posterior dislocation. Surgical management is required and decided on the delay between the trauma and the diagnosis and the importance of the RHS (in percentage). The authors present a chronic locked posterior shoulder dislocation in a 32-year-old active male with a reverse Hill-Sachs lesion of more than 40%. An open reduction was required, and stabilization was achieved with a modified remplissage technique with detachment of the upper quarter of the subscapularis tendon. Three years after the surgery, the patient recovered an excellent functional level with a stable shoulder.

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