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

Abstract

Background: We 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.

Methods: Rotational 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.

Results: The 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.

Conclusions: Proximal 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.

Keywords: Derotational osteotomy; Hill-Sachs lesion; Humerus.

Figure 1

Anteroposterior view of the right shoulder with posterior dislocation and reverse Hill Sachs lesion.

Figure 2

CT scan of the right shoulder axial view showing the posterior dislocation and reverse Hill Sachs lesion.

Figure 3

Intraoperative view of the left shoulder showing the proximal humerus prior to osteotomy.

Figure 4

Anteroposterior view of the right shoulder after the surgery showing the well fixed implant.