Posterior shoulder dislocation with associated reverse Hill-Sachs lesion: treatment options and functional outcome after a 5-year follow up

Abstract

Background: The 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.

Methods: This 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.

Results: Twelve 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).

Conclusion: The 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 registration: 223/2012BO2 , 02 August 2010.

Keywords: Defect size; Osteosynthesis; Outcome; Posterior shoulder dislocation.

Fig. 1

Axial and ap view of posterior shoulder dislocation

Fig. 2

CT scan after posterior shoulder dislocation

Fig. 3

Diagnostic arthroscopy after posterior shoulder dislocation to detect cartilage defects

Fig. 4

Arthroscopic retrograde elevation with target device from cruciate ligament surgery

Fig. 5

Open approach for the treatment with an iliac bone crest graft

Fig. 6

Before and after reconstruction with an autologous graft of the iliac crest with small fragment screws

Fig. 7

Treatment algorithm for posterior shoulder dislocations depending on defect size and timer interval between the trauma and surgery