The posterior bone block and capsular shift in the management of posterior dislocation of the shoulder in adolescents

Summary

Objectives

Stabilization of posterior instability or dislocation of the shoulder in adolescents with a bone block combined with a soft tissue procedure.

Indications

Recurrent posterior instability or dislocation resulting in marked disability after failure of conservative treatment.

Glenoid deficiency and/or generalized ligamentous laxity, both causing a disabling posterior instability or habitual dislocation.

Contraindications

Voluntary dislocation in psychologically unstable patient. Multidirectional instability of the shoulder.

Surgical Technique

Posterior transverse incision following the spine of the scapula. Detachment of the posterior part of the deltoid from the scapular spine. Deepening of approach between infraspinatus and teres minor. Longitudinal division of capsule. Posterior capsular shift. Removal of bone graft from posterior iliac crest and fixation to glenoid neck with 1 or 2 cancellous lag screws. Reefing of the infraspinatus tendon. Reattachment of the deltoid.

Results

Between 1975 and 1998, 3 adolescents with habitual posterior shoulder dislocation were subjected to this procedure (1 boy, 2 girls, average age 14 years). Two adolescents had a posterior bone block and a capsular shift and 1 adolescent had a posterior bone block and a capsular plication. Average length of follow-up 3 years (2 to 4 years). At follow-up all had a full range of motion. Neither pain nor recurrence was observed.