Anatomical reconstruction for Reverse Hill-Sachs lesions after posterior locked shoulder dislocation fracture: a case series of six patients

Abstract

Posterior locked shoulder dislocation fracture is a rare injury. Impression fractures of the humeral articular surface are common with this injury. Different methods exist to restore impression fractures. We present a case series and the results of six patients that had an anatomical repair with spongiotic autograft/allograft for humeral head impression fractures after locked posterior shoulder dislocation. Six patients with an average age of 52.5 years at time of surgery were included. All patients had an anteromedial impression fracture, one patient had an additional two part fracture. The injury was caused by epileptic seizures in five and by direct trauma in one patient. The diagnosis was made on the day of the injury for two patients (33%). For the other patients the time span between the injury and the diagnosis ranged between 5 and 180 days. The impressed cartilage of the defect was first elevated in one piece, the defect filled with the graft and the cartilage fixed on top of the graft by Mitek ancres introduced under the affected area. One patient had an additional two-part fracture that was fixed separately. At a mean time follow-up of 62.7 (18-95) months the result was found to be excellent for two patients and good for four patients with a mean Constant Score of 88.2 points (range 83-98). One patient had a redislocation after three months that was fixed by the same method. At the last follow-up no redislocation or graft collapse was seen. The proposed method of anatomical head reconstruction by spongiotic auto/allograft proved to be a valid and good method to restore shoulder function and stability.