Humeral head impression fracture in acute posterior shoulder dislocation: new surgical technique

Abstract

Posterior shoulder dislocation with humeral head impression fracture is rare and its early diagnosis and treatment remain a challenge for the orthopaedic surgeon. Although literature describes several surgical options, most are based on the detachment of the subscapularis or on more complex techniques that change the humeral joint anatomy even more. This report describes a new operative technique that is only slightly invasive, where the depressed chondral surface is raised to regain a normal articular contour. The chondral surface is supported by an interference biabsorbable screw and the insertion of the subscapularis tendon is left intact. Two male patients with an acute shoulder posterior dislocation associated with anteromedial impression fracture of about 40 and 50%, respectively, of the articular humeral shape were treated in our department. The average follow-up was 26 months where plain X-ray and CT scan showed an anatomical humeral surface free from signs of arthritis or necrosis. Functional results were excellent in both cases. This new technique is easy, less invasive than others and ensures a stable cartilage and subchondral support without the use of grafts.