The dual subscapularis procedure: a modified Hawkins' technique for neglected posterior fracture/dislocation of the shoulder.

Eur J Orthop Surg Traumatol

Department of Orthopaedic Surgery and Trauma, Suez Canal University Hospitals, Kilo 4.5 Ring Road, Ismailia, 41522, Egypt.

Published: July 2019

Background: Posterior fracture/dislocation of the shoulder is a rare injury that is frequently missed on initial assessment. It is frequently associated with reverse Hill-Sachs impression fracture. Several orthopaedics procedures have been described on the literature for reconstructable reverse Hill-Sachs lesion. The McLaughlin's procedure and its modifications, anatomic bone grafting procedures, rotational osteotomies, and the remplissage technique were reported by many authors. We advocated a new "dual subscapularis procedure" that consists of the Hawkins lesser tuberosity transfer with addition of filling the remainder of the defect with a part of subscapularis tendon.

Materials And Methods: In the period between January 2013 to December 2017, 12 patients (13 shoulders) suffering from a delayed managed posterior fracture dislocation were managed. Our inclusion criteria were adult patients less than 60 years presented with reverse Hill-Sachs impression defects from 20 to 50% with or without fractures. For all patients, the dual subscapularis procedure was done. UCLA score was used for postoperative functional assessment.

Results: After a minimum follow-up of 6 months, the results of UCLA score were excellent/good in eight patients and fair/poor in five patients. All patients were found stable after open reduction ± internal fixation with no reported complications. There was a significant correlation of the UCLA score and non-abuse or lower doses of tramadol and the shorter interval between trauma and procedure. Twelve patients were satisfied after the operation.

Conclusion: Reconstructing the reverse Hill-Sachs defect with the dual subscapularis technique provides adequate stability, pain relief, and function in patients with locked chronic posterior shoulder fracture/dislocation. The used technique has the merit of versatility with different fracture patterns, improved fixation of the tendon and increasing the tendon's footprint that ensures extra-articular location of the defect.

Level Of Evidence: II.

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Source
http://dx.doi.org/10.1007/s00590-019-02417-3DOI Listing

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