Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
권호 표지
DOI QR코드

DOI QR Code

Good functional results with open reduction and internal fixation for locked posterior shoulder fracture-dislocation: a case series

  • Nicolas Moran (Shoulder and Elbow Unit, Orthopedic Department, Hospital Militar de Santiago) ;
  • Michael Marsalli (Department of Orthopedic Surgery, Clínica Universidad de Los Andes) ;
  • Mauricio Vargas (Shoulder Surgery Unit, Orthopedic Department, Hospital del Trabajador) ;
  • Joaquin De la Paz (Shoulder Surgery Unit, Orthopedic Department, Hospital del Trabajador) ;
  • Marco Cartaya (Shoulder Surgery Unit, Orthopedic Department, Hospital del Trabajador)
  • Received : 2022.02.23
  • Accepted : 2022.04.15
  • Published : 2022.12.01
Download PDF
⟨ Previous Next ⟩

Abstract

Background: There is no standardized therapeutic strategy for locked posterior shoulder fracture-dislocation (PSFD), and no consensus exists on the analysis of preoperative factors. This retrospective study aimed to evaluate functional results and complications in a series of PSFD cases managed with open surgical treatment. Methods: Patients diagnosed with locked PSFD who underwent open surgical treatment with reduction and osteosynthesis between April 2016 and March 2020 were included. All participants were treated with open reduction and internal fixation. Functional assessment used the modified University of California, Los Angeles (UCLA) mod scale, American Shoulder and Elbow Surgeons (ASES) questionnaire, subjective shoulder value (SSV), and visual analog scale (VAS). Complications were evaluated clinically and radiologically by X-ray and computed tomography. Results: Twelve shoulders were included (11 patients; mean age, 40.6 years; range, 19- 62 years). The mean follow-up duration was 23.3 months (range, 12-63 months). The UCLA mod, ASES, SSV, and VAS scores were 29.1±3.7, 81.6±13.5, 78±14.8, and 1.2±1.4 points, respectively. The overall complication rate was 16.6%, with one case of post-traumatic stiffness, 1 case of chronic pain, and no cases of avascular necrosis. Conclusions: Open surgical treatment of locked PSFD can achieve good functional results. A correct understanding of these injuries and good preoperative planning helped us to achieve a low rate of complications.

Keywords

References

  1. Park HY, Kim SJ, Sur YJ, Jung JW, Kong CG. Treatment of unusual locked posterior fracture-dislocation of the shoulder: a case series. Clin Shoulder Elb 2020;23:190-6. 
  2. Robinson CM, Akhtar A, Mitchell M, Beavis C. Complex posterior fracture-dislocation of the shoulder: epidemiology, injury patterns, and results of operative treatment. J Bone Joint Surg Am 2007;89:1454-66. 
  3. Arafa MS, Abdelbadie A. The dual subscapularis procedure: a modified Hawkins' technique for neglected posterior fracture/dislocation of the shoulder. Eur J Orthop Surg Traumatol 2019;29:999-1007. 
  4. Kokkalis ZT, Iliopoulos ID, Antoniou G, Antoniadou T, Mavrogenis AF, Panagiotopoulos E. Posterior shoulder fracture-dislocation: an update with treatment algorithm. Eur J Orthop Surg Traumatol 2017;27:285-94. 
  5. Demirel M, Ersen A, Karademir G, Atalar AC, Demirhan M. Transfer of the lesser tuberosity for reverse Hill-Sachs lesions after neglected posterior dislocations of the shoulder: a retrospective clinical study of 13 cases. Acta Orthop Traumatol Turc 2017;51:362-6. 
  6. Rouleau DM, Hebert-Davies J, Robinson CM. Acute traumatic posterior shoulder dislocation. J Am Acad Orthop Surg 2014;22:145-52. 
  7. Basal O, Dincer R, Turk B. Locked posterior dislocation of the shoulder: a systematic review. EFORT Open Rev 2018;3:15-23. 
  8. Moroder P, Scheibel M. ABC classification of posterior shoulder instability. Obere Extrem 2017;12:66-74. 
  9. Shams A, El-Sayed M, Gamal O, ElSawy M, Azzam W. Modified technique for reconstructing reverse Hill-Sachs lesion in locked chronic posterior shoulder dislocation. Eur J Orthop Surg Traumatol 2016;26:843-9. 
  10. Cicak N. Posterior dislocation of the shoulder. J Bone Joint Surg Br 2004;86:324-32. 
  11. Gerber C, Catanzaro S, Jundt-Ecker M, Farshad M. Long-term outcome of segmental reconstruction of the humeral head for the treatment of locked posterior dislocation of the shoulder. J Shoulder Elbow Surg 2014;23:1682-90. 
  12. Aydin N, Enes Kayaalp M, Asansu M, Karaismailoglu B. Treatment options for locked posterior shoulder dislocations and clinical outcomes. EFORT Open Rev 2019;4:194-200. 
  13. Aparicio G, Calvo E, Bonilla L, Espejo L, Box R. Neglected traumatic posterior dislocations of the shoulder: controversies on indications for treatment and new CT scan findings. J Orthop Sci 2000;5:37-42. 
  14. Schliemann B, Muder D, Gessmann J, Schildhauer TA, Seybold D. Locked posterior shoulder dislocation: treatment options and clinical outcomes. Arch Orthop Trauma Surg 2011;131:1127-34. 
  15. Ponce BA, Millett PJ, Warner JJ. Management of posterior glenohumeral instability with large humeral head defects. Tech Shoulder Elb Surg 2004;5:146-56. 
  16. McLaughlin HL. Posterior dislocation of the shoulder. J Bone Joint Surg Am 1952;34:584-90. 
  17. Hawkins RJ, Neer CS 2nd, Pianta RM, Mendoza FX. Locked posterior dislocation of the shoulder. J Bone Joint Surg Am 1987;69:9-18. 
  18. Cushner MA, Friedman RJ. Osteonecrosis of the humeral head. J Am Acad Orthop Surg 1997;5:339-46. 
  19. Liu X, Zhu Y, Lu Y, Li F, Wu G, Jiang C. Locked posterior shoulder dislocation associated with isolated fractures of the lesser tuberosity: a clinical study of 22 cases with a minimum of 2-year follow-up. J Orthop Trauma 2015;29:271-5. 
  20. Banerjee M, Balke M, Bouillon B, et al. Excellent results of lesser tuberosity transfer in acute locked posterior shoulder dislocation. Knee Surg Sports Traumatol Arthrosc 2013;21:2884-8. 
  21. Castagna A, Delle Rose G, Borroni M, et al. Modified MacLaughlin procedure in the treatment of neglected posterior dislocation of the shoulder. Chir Organi Mov 2009;93 Suppl 1:S1-5. 
  22. Moroder P, Plachel F, Tauber M, et al. Risk of engagement of bipolar bone defects in posterior shoulder instability. Am J Sports Med 2017;45:2835-9. 
  23. Kemp KA, Sheps DM, Luciak-Corea C, Styles-Tripp F, Buckingham J, Beaupre LA. Systematic review of rotator cuff tears in workers' compensation patients. Occup Med (Lond) 2011;61:556-62.