Locked posterior dislocation shoulder is uncommon and frequently missed injury. It account 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 invented to repair this defect with variable outcomes but evidence based management strategies are lacking. Among these procedures are: 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 9 cases (2 females) of locked posterior shoulder dislocation with antero-medial humeral head defects ranging between 30% – 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, New Jersy). 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 3 cases rated excellent, 4 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 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.
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|||Constant, C.R. and Murley, A.H. (1987) A Clinical Method of Functional Assessment of the Shoulder. Clinical Orthopaedics and Related Research, 160-164.|
|||Checchia, S.L., Santos, P.D. and Miyazaki, A.N. (1998) Surgical Treatment of Acute and Chronic Posterior Fracture Dislocation of the Shoulder. Journal of Shoulder and Elbow Surgery, 7, 53-65.
|||Wadlington, V.R., Hendrix, R.W. and Rogers, L.F. (1992) Computed Tomography of Posterior Fracture-Dislocations of the Shoulder: Case Reports. Journal of Trauma, 32, 113-115.
|||Aparicio, G., Calvo, E., Bonilla, L. and Espejo, L. (2000) Neglected Traumatic Posterior Dislocations of the Shoulder: Controversies on Indications for Treatment and New CT Scan Findings. Journal of Orthopaedic Science, 5, 37-42.
|||McLaughlin, H.L. (1952) Posterior Dislocation of the Shoulder. Journal of Bone and Joint Surgery (America), 24, 584-590.|
|||Cicak, N. (2004) Posterior Dislocation of the Shoulder. Journal of Bone and Joint Surgery (British), 86, 324-332.
|||Keppler, P., Holz, U., Thielemann, F.W. and Meinig, R. (1994) Locked Posterior Dislocation of the Shoulder: Treatment Using Rotational Osteotomy of the Humerus. Journal of Orthopaedic Trauma, 8, 286-292.
|||Gerber, C. and Lambert, S.M. (1996) Allograft Reconstruction of Segmental Defects of the Humeral Head for the Treatment of Chronic Locked Posterior Dislocation of the Shoulder. Journal of Bone and Joint Surgery (America), 78, 376-382.|
|||Ozkan, M., Gul, O., Bacakoglu, K., Ozcan, C. and Ekin, A. (2000) Treatment of Posterior Locked Fracture Dislocation of the Shoulder with Hemiarthroplasty. Acta Orthopaedica et Traumatologica Turcica Journal, 34, 45-49.|
|||Sperling, J.W., Cofield, R.H. and Rowland, C.M. (2004) Minimum Fifteen-Years Follow-Up of Neer Hemiarthroplasty and Total Shoulder Arthroplasty in Patients Aged Fifty Years or Younger. Journal of Shoulder and Elbow Surgery, 13, 604-613.
|||Hawkins, R.J., Neer, C.S., Pianta, R.M. and Mendoza, F.X. (1987) Locked Posterior Dislocation of the Shoulder. Journal of Bone and Joint Surgery, 69, 9-18.|
|||Robinson, C.M. (2005) Posterior Shoulder Dislocations and Fracture Dislocations. Journal of Bone and Joint Surgery (America), 87, 639-650.|
|||Randelli, M. and Gambrioli, P.L. (1986) Glenohumeral Osteometry by Computed Tomography in Normal and Unstable Shoulders. Clinical Orthopaedics and Related Research, 151-156.|
|||Loebenberg, M.I. and Cuomo, F. (2000) The Treatment of Chronic Anterior and Posterior Dislocations of the Glenohumeral Joint and Associated Articular Surface. Orthopedic Clinics of North America, 31, 23-34.
|||Delcogliano, A., Caporaso, A., Chiossi, S. and Delcogliano, M. (2005) Surgical Management of Chronic, Unreduced Posterior Dislocation of the Shoulder. Knee Surgery, Sports Traumatology, Arthroscopy, 13, 151-155.
|||Robinson, C.M., Akhtar, A., Mitchell, M. and Beavis, C. (2007) Complex Posterior Fracture-Dislocation of the Shoulder. Epidemiology, Injury Patterns, and Results of Operative Treatment. Journal of Bone and Joint Surgery, 89, 1454-1466.
|||Bock, P., Kluger, R. and Hintermann, B. (2007) Anatomical Reconstruction for Reverse Hill-Sachs Lesions after Posterior Locked Shoulder Dislocation Fracture. Archives of Orthopaedic and Trauma Surgery, 127, 543-548.
|||Charalambous, C.P., Gullett, T.K. and Ravenscroft, M.J. (2009) Modification of McLaughlin Procedure for Persistent Shoulder Instability: Technical Note. Archives of Orthopaedic and Trauma Surgery, 129, 753-755.