Abstract
BackgroundThe current study describes several surgical techniques for the treatment of the reverse Hill - Sachs lesion after posterior shoulder dislocation; we also aimed to present long term results followed for a minimum of five years.MethodsThis study is a prospective case series of 17 patients who were treated in our clinic between 2008 and 2011. Patients with a defect size smaller than 25% of the articular surface were treated conservatively. An endoprosthesis of the glenohumeral joint was implanted in patients with a defect size bigger than 40%. All remaining patients were treated by a variety of operative techniques, depending on the quality of the bone and size of the defect.ResultsTwelve of seventeen patients had a defect size of the humeral articular surface between 25% and 40% with a mean age of 39 years. Depending on the defect size these patients were treated with retrograde chondral elevation, antegrade cylindrical graft or a graft of the iliac bone crest with an open approach. All the procedures showed fair results, e.g. the open approach with a graft of the iliac bone crest (2010: Dash 3.89, Constant 90.33, Rowe 86.67; 2015: Dash 2.22, Constant 92.00, Rowe 93.33).ConclusionThe open approach is not a disadvantage for the functional outcome. The treatment algorithm should involve the superficial size of the defect as well as the depth of the defect and the time interval between the dislocation and the surgical treatment.Trial registration223/2012BO2, 02 August 2010.
Highlights
The current study describes several surgical techniques for the treatment of the reverse Hill - Sachs lesion after posterior shoulder dislocation; we aimed to present long term results followed for a minimum of five years
Four patients with defects of less than 25% of the articular surface in whom the joint was stable after open reduction were treated conservatively
This study shows the results and techniques of reconstructive treatment options for reverse Hill-Sachs lesion after posterior shoulder dislocation
Summary
The current study describes several surgical techniques for the treatment of the reverse Hill - Sachs lesion after posterior shoulder dislocation; we aimed to present long term results followed for a minimum of five years. An extreme muscle contraction (seizures or electric shock), a direct or indirect trauma that occurs with flexion, adduction and internal rotation of the affected arm, is pathognomonic for the posterior shoulder dislocation [4,5,6]. Cooper first described the typical clinical signs of the posterior shoulder dislocation: dorsal protrusion of the humeral head in accordance with a flattened front shoulder and prominent coracoid, significantly limited or even repealed external rotation, or fixed internal rotation and restricted abduction under 90 degrees [7]. The posterior shoulder dislocation is not detected in the primary examination in 60% to 79% of the Guehring et al BMC Musculoskeletal Disorders (2017) 18:442
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