title: Bilateral neglected posterior fracture-dislocation of the shoulders.
abstract: Posterior dislocation of the shoulder is an uncommon injury. Diagnosis is difficult and often missed. Once diagnosed, management must be individualized depending on the amount of the defect of the humeral head and the time from injury. This article presents a case of a 40-year-old man with a 4-month history of bilateral locked posterior fracture-dislocation of the shoulders after a grand mal seizure. Imaging showed loss of the glenohumeral joint lines congruency, reverse Hill-Sachs lesions, and articular defects of 35% and 40% of the humeral heads. A modified McLaughlin technique was performed in both shoulders in a single stage. Through the standard deltopectoral approach, the lesser tuberosity was osteotomized with the subscapularis and capsule attached and elevated to expose the humeral head and glenoid. The shape of the humeral head was restored by packing the defect with morselized bone allograft. Before packing the allograft into the defect, 2 absorbable suture anchors were inserted at the bottom of the defect; the lesser tuberosity was transferred into the defect, and fixed with 2 transosseous horizontal mattress sutures. Stable fixation was evaluated intraoperatively, and the wound was closed in layers. Postoperatively, both shoulders were immobilized with external rotation braces for 6 weeks, followed by passive, active-assisted, and progressively active range of shoulder motion and rotator cuff strengthening exercises for the next 6 weeks. At 12 weeks postoperatively, full range of motion was accomplished, and full activity was allowed. At 22-month follow-up, the patient was satisfied with his level of function; both shoulder joints were painless and stable without apprehension or recurrence of instability. Radiographs showed congruent joints and complete incorporation of the allograft into the defect with restoration of the shape of the humeral head.
authors.affiliation: First Department of Orthopaedics, Athens University Medical School, Attikon University Hospital, Athens, Greece. kokkaliszinon@yahoo.com
authors.forename: Zinon T
authors.initials: ZT
authors.lastname: Kokkalis
authors.forename: Andreas F
authors.initials: AF
authors.lastname: Mavrogenis
authors.forename: Efstathios G
authors.initials: EG
authors.lastname: Ballas
authors.forename: Panayiotis J
authors.initials: PJ
authors.lastname: Papagelopoulos
authors.forename: Aristides B
authors.initials: AB
authors.lastname: Zoubos
mesh_terms: D000328:Adult; D003951:Diagnostic Errors; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D012783:Shoulder Dislocation / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D012784:Shoulder Fractures / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome