Joint Preserving Treatment of Chronic Locked Posterior Shoulder Dislocation by Means of Combined Humeral Allograft Reconstruction and Posterior Glenoid Autograft Augmentation

Abstract

Chronic locked posterior shoulder dislocations are challenging to treat and often warrant total shoulder arthroplasty. While joint preserving treatment is preferable in young patients, surgical techniques to treat this pathology have rarely been described in the literature. This technical note presents the treatment of a 30-year-old male patient with a chronic locked posterior shoulder dislocation by means of combined humeral allograft reconstruction and posterior glenoid autograft augmentation. Restoration of the spheric humeral head surface was obtained using a fresh-frozen femoral allograft fixed with two reabsorbable screws. Due to the intraoperatively persistent posterior instability after humeral reconstruction, the posterior glenoid was augmented with a tricortical iliac crest autograft, which was fixed with two metal screws. This treatment strategy resulted in a full range of motion and a centered stable shoulder joint at one-year follow-up. Therefore, the procedure of segmental reconstruction of the humeral head with a fresh-frozen allograft combined with a posterior glenoid augmentation with an iliac crest bone autograft is a joint-preserving treatment alternative to shoulder arthroplasty in young patients when humeral head reconstruction alone does not suffice.

Zusammenfassung

Chronisch verhakte hintere Schulterluxationen erfordern häufig einen endoprothetischen Gelenkersatz. Vor allem bei jungen Patienten ist jedoch ein gelenkserhaltender Therapieansatz zu bevorzugen. In diesem Fallbeispiel berichten wir über die Behandlung eines 30-jährigen Patienten mit chronisch verhakter hinteren Schulterluxation mittels kombiniertem humeralen Aufbau und glenoidaler Augmentation. Zur Rekonstruktion der Konvexität des Humeruskopfes erfolgte der Aufbau mit einem fresh-frozen Femur-Allograft, fixiert mit 2 absorbierbaren Magnesiumschrauben. Bei intraoperativ fortbestehender Instabilität wurde zusätzlich das posteriore Glenoid durch einen trikortikalen Beckenkammspan augmentiert. Durch dieses Vorgehen bestand 1-Jahr postoperativ eine freie Beweglichkeit bei zentriertem und stabilem Gelenk. Radiologisch stellt sich das Gelenk zentriert dar, humeral kam es zur partiellen Resorption des Allografts. Deshalb stellt die kombinierte anatomische Rekonstruktion des humeralen Defektes mittels fresh-frozen Femur-Allograft mit zusätzlicher Augmentation des hintern Glenoides mit einem autologen Beckenkammspan eine gelenkserhaltende Therapiealternative bei jungen Patienten mit chronisch verhakter hinterer Schulterluxation dar.

Schlüsselwörter

hintere Schulterinstabilität - inverse Hill-Sachs-Läsion - Glenoiddefekt - Autograft - Allograft

Keywords

Posterior Shoulder Dislocation - reverse Hill-Sachs Lesion - Glenoid Defect - Autograft - Allograft

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