Anatomical reduction and fixation of reverse Hill-Sachs lesion: description of a surgical technique

Abstract

Reverse Hill-Sachs lesions pose a complex challenge in the acute management of posterior shoulder dislocations, often resulting in joint incongruity and compromised function. This article describes a surgical technique for the anatomical reduction and fixation of humeral head impaction injuries, aiming to restore the native sphericity of the articular surface and optimize joint stability. The proposed technique enables the precise realignment of the humeral cartilage and subchondral bone, thereby minimizing residual deformity and preserving the biomechanical integrity of the glenohumeral joint. When indicated, this approach offers a valuable alternative to traditional reconstructive procedures, potentially improving functional outcomes by preventing chronic instability and degenerative changes. The rationale, surgical steps, and key technical considerations are outlined, highlighting the advantages of early intervention in mitigating long-term sequelae.

Keywords: Anatomical reduction; Joint congruency; Posterior shoulder dislocation; Reverse Hill–Sachs; Shoulder instability.

Fig. 1

Exposure through the deltopectoral approach and osteotomy of the lesser tuberosity. A Identification of the long head of the biceps tendon, subscapularis tendon, and lesser tuberosity; B Osteotomy line of the lesser tuberosity exposing the humeral cartilage surface and reverse Hill–Sachs lesion area. Orientation: right shoulder—anterior view

Fig. 2

Reduction and fixation of the impacted osteochondral fragment. A Incomplete osteotomy on the anterolateral humeral head preserving a chondral hinge; humeral cartilage surface and osteochondral lesion visible. B Final fixation with headless cannulated screws; restored humeral head sphericity. Orientation: right shoulder—anterior view

Fig. 3

Postoperative imaging. A Anteroposterior radiograph showing headless cannulated screws and titanium anchors for tuberosity fixation. B Axial CT scan confirming restoration of the articular surface. Orientation: right shoulder

Fig. 4

Schematic representation of the humeral head articular surface in axial CT view. (A) Axial CT schematic representation of the humeral head articular arc. A Pre-traumatic configuration: blue line with arrows indicating the intact articular arc, blue dot marking the humeral head center. B Post-traumatic condition showing the remaining articular arc (blue line) and deficit arc caused by the reverse Hill–Sachs lesion (red line), with posterior glenoid rim engagement zone indicated (red arrow), and blue dot marking the humeral head center. Orientation: right shoulder