Reverse Hill-Sachs Lesion Research Articles

Treatment of Locked Posterior Shoulder Dislocation With Bone Defect.

Locked posterior shoulder dislocation is an uncommon condition and is associated with a reverse Hill-Sachs lesion in 50% of cases. The condition is likely to occur in cases of violent trauma, seizures, or electric shock. Unrecognized dislocation with humeral head fracture affects joint function and humeral head vascularity and may lead to chronic instability, osteonecrosis, and osteoarthritis. A group of 12 patients, including 10 men and 2 women, with neglected locked posterior shoulder dislocation with a reverse Hill-Sachs lesion were treated with the modified McLaughlin technique. The added bone graft from the iliac crest was impacted in the defect and fixed with screws. Mean follow-up was 30 months (range, 24-48 months). The range of forward flexion was 150˚ to 175˚ (average, 165˚), external rotation ranged from 60˚ to 80˚ (average, 75˚), internal rotation ranged from 40˚ to 60˚ (average, 50˚), and average abduction was 150˚ (range, 145˚-160˚). The modified University of California Los Angeles (UCLA) scoring system was used for postoperative clinical evaluation. Total UCLA scores immediately postoperatively ranged from 22 to 28 points (average, 26.5 points) and averaged 30 points (range, 28-33 points) at last follow-up. No recurrence of dislocation occurred during the follow-up period. Of the study patients, 10 returned to their previous job and 2 modified their manual work. The modified McLaughlin technique with added iliac crest bone graft to fill the defect and prevent humeral head deformity is a successful technique for the treatment of patients with chronic locked posterior shoulder dislocation. [Orthopedics. 2017; 40(3):e501-e505.].

Anatomic Humeral Head Reconstruction With Fresh Osteochondral Talus Allograft for Recurrent Glenohumeral Instability With Reverse Hill-Sachs Lesion

The treatment of recurrent glenohumeral instability, especially with a concomitant bony lesion, remains challenging. This is especially true in the case of posterior instability given its less common incidence. Moreover, the presence of an engaging reverse Hill-Sachs lesion in combination with posterior instability will result in the need for a more aggressive treatment option. In comparison with a Hill-Sachs lesion, a reverse Hill-Sachs lesion features greater chondral deficiency that must be addressed during treatment. We propose the talus allograft as a potential allograft for treatment of an engaging reverse Hill-Sachs lesion. The superior articular surface of the talus may be used to reconstruct the articular surface of the humeral head. In this technical note, we describe our preferred primary technique for treatment of an engaging reverse Hill-Sachs lesion with recurrent glenohumeral instability through use of a fresh osteochondral talus allograft, as well as discuss the advantages and disadvantages of this allograft option.

Arthroscopic Reduction and Balloon Humeroplasty in the Treatment of Acute Hill-Sachs Lesions

Shoulder instability is often associated with an impaction fracture of the humeral head, commonly referred to as a “Hill-Sachs lesion.” This lesion is present in both anterior and posterior instability. Forty percent to 90% of anterior shoulder dislocations have associated Hill-Sachs lesions, whereas 29% to 86% of posterior shoulder dislocations have reverse Hill-Sachs lesions. Both of these lesions can contribute to recurrent instability of the shoulder and require surgery to be treated. Currently, the most common procedures to address Hill-Sachs lesions are the remplissage procedure (transfer of the infraspinatus into the posterior humeral head defect), capsular shift, disimpaction technique, humeral head resurfacing, bone block transfer, or shoulder arthroplasty. Reverse Hill-Sachs lesions are managed with similar procedures, such as the remplissage-equivalent technique described by McLaughlin, which involves transfer of the subscapularis tendon to fill the humeral head defect. The procedure has the advantage of “exteriorizing” the humeral head defect, but in the case of large lesions, it can result in significant loss of the articulating articular surface. The purpose of this article is to describe an arthroscopically assisted disimpaction technique with supplemental grafting using a balloon osteoplasty technique for a reverse Hill-Sachs lesion with bone cement to support and maintain the reduction.

Modified technique for reconstructing reverse Hill-Sachs lesion in locked chronic posterior shoulder dislocation.

Among the uncommon and frequently missed orthopedics injuries is the posterior shoulder dislocation, accounting for about 2-4% of all shoulder dislocations. Commonly, it is associated with the well-known reverse Hill-Sachs lesion. Several surgical treatment modalities such as transfer of subscapularis tendon or lesser tuberosity, humeral rotational osteotomy, osteochondral grafts were used to repair this defect. Hemiarthroplasty or total shoulder arthroplasty was used as salvage procedure in non-constructable defect or neglected old dislocation. This study included 11 patients with locked chronic posterior shoulder dislocation and reverse Hill-Sachs defects falling in the target range (25-50% of the head size). The mean age of the patients was 39 (range 31-49) years. Mean time from injury to surgery was 9 (range 3-18) weeks. Open reduction in the dislocated head with the transfer of subscapularis tendon and the attached lesser tuberosity was done to reconstruct the reverse Hill-Sachs defect. The transferred tuberosity was fixed with size 5 Ethibond sutures. The mean follow-up period was 29 (range 24-39) months. The median of the scores was much improved, reaching 30 (range 20-34) (satisfactory) compared with preoperative median of 24 (range 20-25) (unsatisfactory). This was statistically highly significant (P=0.002). Postoperatively, 9 patients had no pain or restricted daily living activities. No patient had symptoms of shoulder instability. According to the modified UCLA shoulder rating scale, there were 4 patients rated excellent, 5 patients rated good, one patient rated fair and one patient rated poor. Reconstructing the reverse Hill-Sachs defect provides adequate stability, pain relief and function in patients with locked chronic posterior shoulder dislocation and a defect involving 25-50% of the humeral head. The used technique is simple and cost effective with no need for subsequent hardware removal. II.

Neglected posterior shoulder dislocation treated with anatomic reconstruction for bipolar bone defects of humeral head and posterior glenoid: A case report and literature reviews

Treatment of chronic posterior shoulder dislocation remains difficult. Currently, there is no consensus on how to treat these cases. In this report, we present a uncommon case of a 42-yearold man with neglected posterior shoulder dislocation, a reverse Hill-Sachs lesion, and a defect of the posterior glenoid. We show our treatments and reviews articles about posterior shoulder dislocations.

Missed posterior shoulder dislocation and McLaughlin lesion after an electrocution accident

Posterior shoulder dislocation is a rare event that may occur after a direct trauma, an epileptic seizure, electric shock or electroconvulsive therapy. In more than 50% of the cases, posterior dislocations are missed on initial evaluation and often misdiagnosed as frozen shoulders with unfortunate consequences. We present the case of a missed posterior subluxation and reverse Hill Sachs lesion (McLaughlin lesion) in a 40-year-old woman caused by anelectric shock of 240V. The patient underwent surgery in our institute two weeks after the injury. The humeral head was reduced and the reverse Hill Sachs lesion was filled by demineralized bone matrix allograft with osteoinductive factors. Tendons were repaired and a temporaneous artrodesis was performed. At the final follow up of 12 months, we obtained a Costant Score of 93 and the patient returned to her previous daily activities.

Arthroscopic Reverse Remplissage for Posterior Instability

Posterior shoulder dislocation is an unusual injury often associated with electrical shock or seizure. As with anterior instability, patients frequently present with an impaction injury to the anterior aspect of the humeral head known as a “reverse Hill-Sachs lesion.” The treatment of this bony defect is controversial, and multiple surgical procedures to fill the defect in an effort to decrease recurrence have been described. Most of the reports have focused on an open approach using variations of lesser tuberosity and subscapularis transfers, bone allograft, and even arthroplasty to assist with persistent instability. We advocate an arthroscopic technique that involves a suture anchor–based distal tenodesis of the subscapularis tendon or a reverse remplissage procedure.

Defect Characteristics of Reverse Hill-Sachs Lesions

Background: Little scientific evidence regarding reverse Hill-Sachs lesions (RHSLs) in posterior shoulder instability exists. Recently, standardized measurement methods of the size and localization were introduced, and the biomechanical effect of the extent and position of the defects on the risk of re-engagement was determined. Purpose: To analyze the characteristics and patterns of RHSLs in a large case series using standardized measurements and to interpret the results based on the newly available biomechanical findings. Study Design: Case series; Level of evidence, 4. Methods: In this multicenter study, 102 cases of RHSLs in 99 patients were collected from 7 different shoulder centers between 2004 and 2013. Patient- as well as injury-specific information was gathered, and defect characteristics in terms of the size, localization, and depth index were determined on computed tomography or magnetic resonance imaging scans by means of standardized measurements. Additionally, the position (gamma angle) of the posterior defect margin as a predictor of re-engagement was analyzed. Results: Three types of an RHSL were distinguished based on the pathogenesis and chronicity of the lesion: dislocation (D), locked dislocation (LD), and chronic locked dislocation (CLD). While the localization of the defects did not vary significantly between the subgroups (P = .072), their mean size differed signficantly (D: 32.6° ± 11.7°, LD: 49.4° ± 17.2°, CLD: 64.1° ± 20.7°; P < .001). The mean gamma angle as a predictor of re-engagement was similarly significantly different between groups (D: 83.8° ± 14.5°, LD: 96.5° ± 17.9°, CLD: 108.7° ± 18.4°; P < .001). The orientation of the posterior defect margin was consistently quite parallel to the humeral shaft axis, with a mean difference of 0.3° ± 8.1°. Conclusion: The distinction between the 3 different RHSL types based on the pathogenesis and chronicity of the defect helps identify defects prone to re-engagement. The gamma angle as a measurement of the position of the posterior defect margin and therefore a predictor of re-engagement varies significantly between the defect types.

Posterior bone block: a reliable method to treat recurrent nonlocked posterior shoulder dislocation with engaging reverse Hill–Sachs lesion

Background Posterior shoulder dislocation was first reported in 1839 by Sir Astley Cooper. Hill and Sachs, in 1940, stated that with any dislocation event the soft bone of the humeral head impacts against the harder, sharper edge of the glenoid, leading to an impression fracture of the posterosuperior head in recurrent anterior dislocation. A reverse Hill–Sachs lesion is an impression fracture in the anterosuperior head in recurrent posterior dislocation. In 1952, McLaughlin described his surgical technique to treat an anterior impression fracture of the humerus after recurrent posterior shoulder dislocation. Hypothesis Our hypothesis is to prove that posterior bone block augmentation of the posterior glenoid is a safe and reliable line of treatment in cases of recurrent posterior instability with engaging reverse Hill–Sachs lesion. Patients and methods Between March 2009 and March 2011 five cases were referred to us with chronic recurrent posterior shoulder dislocation with engaging reverse Hill–Sachs lesion. The mean age of the patients was 28 years (range: 20–36 years). There were two left and three right shoulders. All patients were male. All patients were manual workers. All sustained traumatic dislocations through nonathletic accidents. None of the patients had epileptic fits before. Preoperatively, the mean active forward elevation was 140° (range: 130°–150°) and external rotation with the arm at the side was 35° (range: 20°–50°). Preoperative constant score average was 40 points (range: 30–50 points). The mean time interval between injury and surgery was 12 months (range: 8–16 months). All cases had engaging reverse Hill–Sachs lesion. None of the cases had significant posterior glenoid bone loss. All patients were treated with open posterior bone block augmentation of the posterior glenoid harvested from the anterior iliac crest. Results Patients were evaluated at 3, 6, 12, and 24 months. Range of motion was recorded and follow-up radiographs were taken to evaluate graft incorporation. The mean follow-up time for the five patients was 30 months (range: 24–36 months). At 6 months postoperatively, the mean forward elevation was 165° (range: 160°–170°) and external rotation with the arm at the side was 55° (range: 40°–70°). Patients were evaluated postoperatively according to the constant score system (maximum: 100 points). We found a mean postoperative constant score of 87.5 points (range: 80–95 points), a fairly good result considering the nature of bone loss. Conclusion The posterior bone block can successfully restore the stability and function of the shoulder in patients with recurrent posterior dislocations with significant engaging reverse Hill–Sachs lesion in which arthroscopic soft-tissue reconstruction is not a reasonable option. This technique can be used for combined soft tissue and bony defects as well as for revisions after previous soft-tissue reconstructions.

Posterior Humeral Avulsion of the Glenohumeral Ligament and Associated Injuries

Background: Lesions associated with posterior humeral avulsion of the glenohumeral ligament (HAGL) can lead to persistent symptoms related to posterior shoulder instability and can be commonly missed or delayed in diagnosis. Purpose: To identify and characterize the MRI findings in patients with a posterior HAGL lesion. Study Design: Case series; Level of evidence, 4. Methods: This retrospective case series included 27 patients (28 shoulders) identified by search through the senior authors’ databases, with cross-reference to their institutional radiologic communication system for MRI review. Baseline patient demographic data were collected, including age and sex. All posterior HAGL lesions were identified on MRI and characterized as partial, complete, or floating lesions. All acute glenohumeral pathologic changes concurrent with the posterior HAGL were documented. Chondrolabral retroversion of the injured shoulder was measured on axial MRI. Results: The average age of the identified cohort was 33.6 years (range, 15-81 years), and 23 patients were male (86%). Posterior HAGL injuries were found to be complete tears (71%), partial tears (25%), and floating lesions (4%); concomitant bony HAGL avulsion was found in 7% of injuries. Additional traumatic glenohumeral disorders occurred in 93% of cases. The most common concurrent injuries were reverse Hill-Sachs lesions (36%), anterior Bankart lesions (29%), and posterosuperior rotator cuff tears (25%). Notably, concomitant anterior labral or capsular injury was found in 50% of patients, signifying bidirectional disruption of the capsule. In addition, increased chondrolabral version was found in this cohort (10.2° ± 3.7° retroversion). Conclusion: This study depicts the high association of combined injury with posterior HAGL lesions and increased chondrolabral retroversion. Findings on MRI related to a posterior HAGL injury could potentially be masked by additional injury and may occur with mechanisms that also lead to anterior glenohumeral disorders.

New technique in reconstructing humeral head defect in locked posterior dislocation of the shoulder: a case series of nine patients

Locked posterior dislocation of the shoulder is uncommon and frequently missed injury. It accounts 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 are invented to repair this defect with variable outcomes, but evidence-based management strategies are lacking. Among these procedures are as follows: 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 nine cases (two females) of locked posterior dislocation of the shoulder with anteromedial humeral head defects ranging between 30 and 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, NJ). 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 three cases rated excellent, four 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 of the shoulder 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.

Proximal humerus derotational osteotomy for internal rotation instability after locked posterior shoulder dislocation: early experience in four patients.

BackgroundWe performed a retrospective and descriptive study to determine the feasibility of proximal humerus derotational osteotomy in younger patients with significant humeral head depression, who may not be good candidates for shoulder arthroplasty.MethodsRotational osteotomy was done on four patients with a mean age of 40 for locked posterior dislocation associated with a reverse Hill-Sachs lesion from 2000–2011. The average age was 40 +/− 11 years old and the average follow up was 22 +/− 8 months. Shoulder stability, range of motion, radiographic outcome and postoperative complications were assessed. Average follow-up was 22 months (range, 12–30 months) postoperatively.ResultsThe average range of motion of the shoulders at the final follow-up were as follows (Mean +/− Standard deviation): Abduction: 125 +/− 29°, Forward flexion: 135 +/− 17°, Internal rotation: 65 +/− 17°, External rotation: 62 +/− 10°. There were no wound or neurological complications and no dislocations. Patients were satisfied with their functional status and did not have any further symptoms of instability or rotator cuff dysfunction.ConclusionsProximal humerus derotational osteotomy for acute locked posterior dislocation of the shoulder can be a viable option for younger age group, which can facilitate rehabilitation for these patients by providing immediate stability.

Acute shoulder trauma: what the surgeon wants to know.

Many excellent studies on shoulder imaging from a radiologic perspective have been published over the years, demonstrating the anatomy and radiologic findings of shoulder trauma. However, it may not always be clear what the surgeon, who bears the responsibility for treating the injured patient, really needs to know about the injury to predict outcomes and plan management. The authors review the relevant osseous, soft-tissue, and vascular anatomy and describe the clinically relevant concepts that affect management. Familiarity with the Neer classification system for proximal humerus fractures can have a significant impact on treatment. The length and displacement of the medial humeral metaphyseal fragment helps predict the risk of ischemia in proximal humerus fractures. The Nofsinger approach for measuring the area of glenoid fossa bone loss can help the surgeon determine the need for surgical repair of a bony Bankart lesion. The size of Hill-Sachs and reverse Hill-Sachs lesions is also an important predictor of stability. The Ideberg classification system for intraarticular fractures of the glenoid fossa, combined with information on instability and joint incongruity, helps determine the need for surgical fixation of glenoid fossa fractures. Awareness of what matters to the surgeon can help radiologists better determine where to focus their attention and efforts when describing acute shoulder trauma.

Influence of Defect Size and Localization on the Engagement of Reverse Hill-Sachs Lesions

Background: Reverse Hill-Sachs (RHS) lesions can cause recurrent posterior shoulder instability because of engagement with the posterior glenoid rim; however, the effect of defect size and localization have yet to be determined. Hypothesis: Both size and localization are critical for the engagement of an RHS defect with the posterior glenoid rim. Study design: Controlled laboratory study. Methods: Ten RHS defects with predefined extent and localization were created through an anterolateral rotator cuff sparing approach in 10 fresh-frozen cadaveric shoulder specimens using a custom-made saw guide. Computed tomography scans of all specimens were completed, and standardized measurements were performed to determine the size (alpha angle) and localization (beta angle) of the defect as well as a combination of both parameters (gamma angle). Internal rotation motions were imposed on the shoulder joint in different arm positions and with varying amount of posterior translation by means of a robot-assisted shoulder simulator. The association between engagement of the defects and the defined parameters (alpha, beta, and gamma angles) was analyzed. Results: In 0° of abduction, a cutoff value between engaging and nonengaging defects of 37.5° for the alpha angle (100% sensitivity; 75% specificity; area under the curve [AUC], 0.875; P = .055) and 36.5° for the beta angle (100% sensitivity; 25% specificity; AUC, 0.708; P = .286) was determined. The gamma angle showed the highest discriminatory power (AUC, 0.938; P = .025) with a cutoff value of 85.5° rendering 100% sensitivity and 75% specificity in the prediction of engagement. An increase in the applied posterior translation force decreased the degrees of internal rotation necessary before engagement occurred. No engagement occurred during internal rotation with the arm in 60° of abduction or 60° of flexion. Conclusion: The size and localization of RHS defects are both critical factors for engagement. The combination of both parameters in terms of the gamma angle measurement might be a helpful tool to identify defects prone to engagement. Clinical Relevance: Not only the size but also the localization is decisive for engagement of RHS defects. The standardized measurement of the gamma angle combines both factors and might be a helpful tool to identify defects prone to engagement warranting surgical treatment.

Reconstruction of Humeral Head Defect in Locked Posterior Dislocation Shoulder. A Case Series of Nine Patients

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.

The Evaluation of Hill-Sachs Injuries and the Use of Humeral Head Allograft for Repair of Hill-Sachs and Reverse Hill-Sachs Injuries

The human shoulder is an inherently stable joint. Changes within the anatomical structure of the shoulder, both static and dynamic, allow for significant movement in multiple planes, making the shoulder one of the most commonly dislocated joints in the body. Anterior glenohumeral dislocation can result in glenoid bone loss because of fracture abrasion or the compression of the anterior inferior glenoid against the posterior lateral aspect of the humeral head known as a lesion. Posterior shoulder instability is a much more rare injury, which may result in significant bone defects of the anterior humeral head. Often, small defects are addressed by soft tissue repair, whereas larger defects may require a bony procedure, such as the use of humeral head allograft for the repair of Hill-Sachs and reverse Hill-Sachs lesions.

Posterior Shoulder Dislocation Due to an Atypical Trauma Mechanism

Objectives:A 32 year old man who was admitted to the emergency department with serious pain and absent movement of the right upper extremity due to passing the ball in a basketball game. He had no shoulder dislocation in his medical history. The right shoulder position was flexion and adduction. The shoulder range of motion was restricted and the neurovascular examination was intact. Posterior shoulder dislocation was diagnosed in radiographs.The aim of the study is pointed out an unusual mechanism of the posterior shoulder dislocations which is related microtrauma. The main problem in treatment of this kind of dislocation is correct and timely diagnosis.Methods:After diagnosing the posterior shoulder dislocation, we reducted the shoulder joint immediately and immobilized in abduction and external rotation with Velpeau bandage. We took radiographs and computerized tomography to confirm the reduction of the joint and diagnose the additional bone pathology. Reverse Hill Sacks lesion was diagnosed. Two weeks later after diagnosing passive range of movement exercises were applied. Magnetic resonance imaging was done to diagnose the additional pathology.Results:There was no spesific finding in radiographs and reverse Hill Sachs lesion and anterior labral tear were determined in magnetic images finding.Conclusion:Shoulder joint dislocations are the most seen pathology in the emergency department. On the other hand posterior shoulder dislocations are less common than anterior dislocations, but more commonly missed. Posterior shoulder dislocations are caused by high energy trauma, seizures, electric shocks and microtrauma.

Treatment of Bone Defects in Posterior Instability

When compared with anterior glenohumeral instability, posterior glenohumeral instability is a relatively rare condition, and it can pose a diagnostic and therapeutic challenge for the orthopaedic surgeon. Although many patients only have damage to the posterior capsulolabral structures, some have bone defects associated with posterior instability, including defects of the posterior glenoid rim, glenoid retroversion, and an anterosuperior impaction fracture of the humeral head known as the reverse Hill-Sachs lesion. When nonoperative treatments fail, surgical management aims to identify and address both soft tissue and bony factors involved in posterior instability so as to minimize the chances of recurrent instability after surgery. Operative treatment options vary for these different bone defects associated with posterior instability, and there are relatively little data to guide surgical indications and treatment decisions. In this article, we discuss our approach to the treatment of bone defects in posterior instability with emphasis on which techniques are used in different circumstances as well as technical pearls and pitfalls.

Combination of a floating clavicle and a posterior shoulder dislocation: An "Unhappy Triad" of the shoulder girdle

We present a case of a 31-year-old man who suffered from a floating clavicle in combination with a reverse Hill-Sachs lesion of his right shoulder girdle after a bicycle accident. Operative treatment was performed using minimal-invasive and arthroscopically assisted techniques.We strongly recommend an early CT scan with later 3-dimensional reconstruction to detect and fully understand these complex injuries.

English

BACKGROUND: Posterior shoulder dislocations and fracture-dislocations are uncommon injuries that most often occur during seizures or as a result of high-energy trauma. Despite advances in imaging, they are frequently diagnosed late. Detection is facilitated by heightened clinical suspicion of the injury in high-risk individuals together with appropriate radiographic investigation. A wide variety of operative techniques, ranging from simple closed reduction to soft-tissue and bone stabilization procedures to prosthetic arthroplasty, are available to treat these injuries. Selection of the most appropriate treatment option is complex and multifactorial. Good functional outcomes are associated with early detection and treatment of isolated posterior dislocations that are associated with a small osseous defect and are stable following closed reduction. Poor prognostic factors include late diagnosis, a large anterior defect in the humeral head, four part fracture or arthrosis of the humeral head. CASE DESCRIPTION: A 24 year old male worker presented with persisting pain and stiffness in his right shoulder following high energy trauma 8 months back. Physical examination and radiological evidence showed posterior dislocation with humeral head fracture. Patient was treated by open reduction and reconstruction of the proximal humerus. Post operative follow up for 18 months showed good range of movements. Early diagnosis and treatment of this rare type can prevent deformities. INTRODUCTION: Posterior locked shoulder dislocation is an uncommon injury (2–4% of all shoulder dislocations) which may be misdiagnosed and overlooked in up to 60% of cases.1 The spectrum of associated injuries varies from the isolated impaction fracture of the anteromedial aspect of the humeral head (reverse Hill-Sachs lesion) to more complex fracture types of the proximal humerus (less than 1%) and shoulder girdle 1, 2. The unrecognized dislocation-fracture pattern can jeopardize the joint mobility and the vascularity of the humeral head predisposing to chronic instability, osteonecrosis and osteoarthritis .1 The management of posterior fracture dislocation after delayed diagnosis is complicated.3 CASE PRESENTATION: A 24-year-old right-hand dominant male worker, presented at the Vydehi Hospital complaining of persisting pain and stiffness in his right shoulder. The symptoms began 8 months earlier following a high energy trauma. The patient reported that he had taken native treatment with an osteopath where serial massages were done to relieve the pain, as there was no improvement in pain and shoulder mobility; he finally was referred to our hospital for a second opinion and further evaluation.