Balloon osteoplasty--a new technique for minimally invasive reduction and stabilisation of Hill-Sachs lesions of the humeral head: a cadaver study.
OBJECTIVE
Traumatic shoulder dislocation may be complicated by concomitant bony injury of the glenoid rim or the humeral head. In Hill-Sachs lesions, reconstruction techniques vary widely and range from open reduction to tendon transposition or humeral head derotation. These operations are extensive and have questionable outcomes. With the expertise from vertebral compression fracture reduction by kyphoplasty, we examined in a cadaver feasibility study whether reduction of the Hill-Sachs lesion via hydraulic lift might be an anatomical and minimally invasive treatment option. We postulated that the use a of a balloon- assisted kyphoplasty reduction could achieve almost anatomical correction of the defect.


METHODS
We created Hill-Sachs lesions in six humeral specimens and performed a computed tomography (CT) scan before and after reduction with the kyphoplasty system. The entry point at the greater tuberosity and balloon positioning was visualised by fluoroscopy. The size of the Hill-Sachs lesion before and after reduction was measured using CT scans in the axial orientation.


RESULTS
Using the balloon kyphoplasty system, we achieved a statistically significant reduction (80 % ) of the Hill-Sachs lesion.


CONCLUSIONS
In a preliminary cadaver study we show that using a balloon kyphoplasty system might be an alternative treatment option for Hill-Sachs lesions, with reduced collateral damage that can occur with other minimally invasive techniques. Future work is needed to evaluate the technique under arthroscopic conditions.
Department of Traumatology, Klinikum rechts der Isar, Technische Universitaet Muenchen, Ismaninger Strasse 22, 81675 Munich, Germany. Gunther.Sandmann@mri.tum.de
Gunther H
GH
Sandmann
Philipp
P
Ahrens
Christoph
C
Schaeffeler
Jan S
JS
Bauer
Chlodwig
C
Kirchhoff
Frank
F
Martetschläger
Dirk
D
Müller
Sebastian
S
Siebenlist
Peter
P
Biberthaler
Ulrich
U
Stöckle
Thomas
T
Freude
D000368:Aged; D017760:Bone Malalignment / Q000517:prevention & control; D002102:Cadaver; D005240:Feasibility Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D058430:Humeral Head / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D057072:Intra-Articular Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D058498:Kyphoplasty / Q000379:methods; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012782:Shoulder / Q000000981:diagnostic imaging / Q000601:surgery; D012783:Shoulder Dislocation / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D012785:Shoulder Joint / Q000503:physiopathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed