Title: Orthopedics

Abstract:

Posterior dislocation of the shoulder is a rare event that often occurs as a consequence of a direct trauma or epileptic crisis. Frequently the posterior dislocations are missed, so they become neglected lesions. It can be a challenging clinical entity for orthopedic surgeons to treat this pathology. In the setting of a posterior dislocation, a large anterior humeral impaction injury (reverse Hill-Sachs) may occur, leading to engagement of the humerus with the posterior glenoid rim. A reverse Hill-Sachs is especially debilitating because of the significant portion of affected humeral head cartilage. Recent practice favors the anatomic reconstruction consisting of restoration of the cartilage surface of the humeral head using bone grafts (auto graft or allograft) to restore the articular contour of the humeral head. We present a small case series of 3 patients at our center presented with an acute posterior shoulder dislocation with reverse Hill-Sachs lesion which involved more than 25% of the articular surface of the humeral head. All the cases were managed with open reduction, relocation and restoration of humeral head using autograft (iliac crest).  Kirshner wires were used to augment the stability temporarily till the time soft tissue heals. All three patients showed excellent functional and radiological results at the follow up examinations, with almost full range of shoulder movements and complete regain of previous activities of daily living. Posterior dislocation of the shoulder is a challenging lesion, hard to recognize and to treat. Our method of treatment is highly reproducible and has revealed itself to be very effective in achieving good results. 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.

Biography: