Lussazione inveterata posteriore della spalla. Principi di trattamento

Abstract

Chronic posterior dislocation of the shoulder is the result of a missed posterior acute dislocation. It is characterized by a damage to the humeral head: the McLaughlin anterolateral humeral defect. In type 1 the humeral defect involves 20% to 50% of the humeral articular surface and it may be treated by closed reduction (in recent lesions) or transposition of the subscapularis tendon or by means of bone allograft. In type 2 the humeral defect is more than 50% of the surface. A bone allograft or prosthetic surgery may be indicated. Type 3 is a posterior fracture-dislocation of the humeral head, with preserved humeral surface. The ORIF is the preferred treatment. Type 4 is a multi-fragmented fracture-dislocation of the head; here a shoulder arthroplasty is the treatment of choice. The results of these techniques are generally satisfactory, if the treatment choices are correctly adapted to the anatomical and clinical patient’s condition.