New technique in reconstructing humeral head defect in locked posterior dislocation of the shoulder: a case series of nine patients

Abstract

Locked posterior dislocation of the shoulder is uncommon and frequently missed injury. It accounts for 2–4 % of all shoulder dislocations. It is commonly associated with osseous defects in humeral head articular surface known as reverse Hill-Sachs lesion. Numerous surgical procedures are invented to repair this defect with variable outcomes, but evidence-based management strategies are lacking. Among these procedures are as follows: transfer of lesser tuberosity or subscapularis tendon, rotational osteotomy of humerus, osteochondral grafts. Salvage procedure as hemiarthroplasty or total shoulder arthroplasty used in huge non-constructable defect or very old neglected dislocation. In our case series, we treated nine cases (two females) of locked posterior dislocation of the shoulder with anteromedial humeral head defects ranging between 30 and 50 % of head size. Open reduction of dislocation followed by transfer of the lesser tuberosity together with subscapularis tendon for reconstruction of the humeral head defect. The transfer was fixed with Ethibond suture size 5–0 (Ethicon, Inc. Somerville, NJ). The mean follow-up period was 14.5 months (range 12–25 months). Seven cases had no pain or restriction of activities of daily living. No patient had symptoms of instability of the shoulder. According to UCLA shoulder rating scale, there were three cases rated excellent, four cases rated good, one case rated fair, and one case rated poor. It is concluded that reconstruction of the humeral head defect provides good pain relief, stability, and function for patients with a locked posterior dislocation of the shoulder where the defect involves between 30–50 % of the articular surface circumference. Our technique is simple, cheap, and there is no need for second operation for hardware removal.