Date: 18 Mar 2010

Osteochondral allograft reconstruction of segmental defect of humeral head after posterior dislocation of the shoulder

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Abstract

Introduction

Posterior shoulder dislocations are rare and almost 50% are associated with fractures of the humeral head. Although, there are only few articles describing specific treatments for the humeral head defects.

Case report

In this paper, authors described a typical case of a 42-year-old patient with a posterior shoulder dislocation initially misdiagnosed. Patient had before undergone two surgeries of this shoulder for anterior shoulder instability with a coracoid and iliac bone block autograft. The diagnosis was confirmed with appropriate plain films and a CT scan. Moreover, the CT scan allows us to evaluate the size of the anteromedial defect of the humeral head which comprised about 30 to 40% of the humeral head. The surgical treatment consisted on a deltopectoral approach, and the defect was filled with a cryopreserved allogeneic segment of femoral head contoured to restore the spherical shape, and was fixed with three screws Biotech® 2.3 mm of diameter. Six months after surgery, the patient was doing quite well with no complaints, and CT scan showed humeral head with incorporation of the graft and no evidence of collapse. On the MRI imaging 1 year after surgery, no osteonecrosis was diagnosed.

Discussion

This procedure seems to be a good alternative for treatment of posterior shoulder dislocation with a large humeral head defect and to be particularly indicated for young people with a good quality of the residual head and an absence of relevant osteoarthrosis.