title: Weber osteotomy for large Hill-Sachs Defects: clinical and CT assessments.
abstract: BACKGROUND
  The Weber derotation osteotomy is an uncommon procedure that typically is reserved for patients with engaging Hill-Sachs defects who have had other surgical treatments for shoulder instability fail. It is unknown whether the desired humeral derotation actually is achieved with the Weber osteotomy.
  
  
  OBJECTIVE
  The purposes of this study were to answer the following questions: (1) What are the complication (including redislocation) and reoperation rates of the Weber osteotomy? (2) What are the American Shoulder and Elbow Surgeons (ASES) and functional (ROM in internal rotation, self care) results? (3) What fraction of the patients had humeral derotation within 10° of the desired rotation?
  
  
  METHODS
  A chart review of 19 Weber osteotomies and clinical assessment of 10 Weber osteotomies were performed by independent clinicians. The chart review, at a mean followup of 51 months (range, 13-148 months), focused on the complication rate and the frequency of redislocation. The clinical and CT assessments, at a mean followup of 54 months (range, 26-151 months), focused on ASES scores, ability of patients to perform self care with the affected arm, and CT scans to measure change in humeral retroversion.
  
  
  RESULTS
  There were 25 complications and nine reoperations in 17 patients (19 shoulders), including pain (six patients, of whom one had complex regional pain syndrome), hematoma, infection, nonunion, delayed union, reoperations related to hardware and other noninstability-related causes (five patients), and internal rotation deficit. Redislocation occurred in one patient, who underwent repeat surgery, and subjective instability developed in two others. The mean ASES score was 78 points (of 100 points); six of the 10 patients (11 procedures) evaluated in person found it difficult or were unable to wash their backs with the affected arm. Humeral derotation varied from 7° to 77°; only three of the nine patients for whom CT scans were available had derotation within 10° of the desired rotation.
  
  
  CONCLUSIONS
  Complication rates with the Weber osteotomy were much higher than previously reported. Because seven of 17 patients were lost to followup, the redislocation rate may be higher than we observed here. Given the unpredictable variability in humeral derotation achieved with a Weber osteotomy, an improved surgical technique is critical to avoid osteoarthritis and loss of internal rotation associated with overrotation.
authors: Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Sea to Sky Orthopaedics, Squamish General Hospital & Whistler Health Care Centre, PO Box 1275, Whistler, BC, V0N 1B0, Canada. drbrookshill@gmail.com
authors: Alexandra L
authors: AL
authors: Brooks-Hill
authors: Bruce B
authors: BB
authors: Forster
authors: Case
authors: C
authors: van Wyngaarden
authors: Robert
authors: R
authors: Hawkins
authors: William D
authors: WD
authors: Regan
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D060751:Bone Retroversion / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D006811:Humerus / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D011237:Predictive Value of Tests; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012648:Self Care; D012783:Shoulder Dislocation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012785:Shoulder Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
references: Chir Narzadow Ruchu Ortop Pol. 2004;69(5):301-3
references: 15751717
references: Can J Surg. 2009 Jun;52(3):249-54
references: 19503672
references: Arthroscopy. 1989;5(4):254-7
references: 2590322
references: J Bone Joint Surg Am. 1984 Feb;66(2):159-68
references: 6693441
references: J Shoulder Elbow Surg. 1996 Sep-Oct;5(5):393-400
references: 8933462
references: Arthroscopy. 2008 Jun;24(6):723-6
references: 18514117
references: J Bone Joint Surg Am. 1984 Dec;66(9):1443-50
references: 6501339
references: Am J Sports Med. 2002 Jan-Feb;30(1):116-20
references: 11799007
references: Arthroscopy. 2006 Jul;22(7):798.e1-4
references: 16848061
references: J Bone Joint Surg Am. 2002 Oct;84(10):1753-62
references: 12377904
references: Arthroscopy. 2005 Aug;21(8):1007
references: 16086562
references: J Orthop Trauma. 1991;5(2):129-33
references: 1861186
references: Am J Sports Med. 2011 Aug;39(8):1640-7
references: 21505080
references: Z Orthop Ihre Grenzgeb. 1983 Sep-Oct;121(5):541-6
references: 6649798
references: Acta Orthop Belg. 2012 Feb;78(1):117-20
references: 22523938
references: J Bone Joint Surg Br. 1995 Nov;77(6):924-7
references: 7593108
references: Z Unfallmed Berufskr. 1973;66(3):130-8
references: 4776346
references: Arthroscopy. 2000 Oct;16(7):677-94
references: 11027751
references: J Orthop Surg Res. 2011 Jun 15;6:29
references: 21676226
references: Injury. 2002 Nov;33(9):791-4
references: 12379389
references: J Bone Joint Surg Am. 2005 Jun;87(6):1312-22
references: 15930542
references: J Bone Joint Surg Am. 2012 Apr 4;94(7):618-26
references: 22488618
references: Unfallheilkunde. 1983 Mar;86(3):87-95
references: 6845548
references: Acta Orthop Belg. 2007 Apr;73(2):175-8
references: 17515227
references: Z Unfallchir Versicherungsmed. 1993;86(1):18-21
references: 8357683
references: Am J Sports Med. 2011 Oct;39(10):2147-52
references: 21816983
references: Acta Chir Orthop Traumatol Cech. 2010 Oct;77(5):402-10
references: 21040652
references: Unfallchirurg. 1997 Mar;100(3):198-204
references: 9173548
references: Arthroscopy. 2005 Dec;21(12):1473-8
references: 16376238
references: J Shoulder Elbow Surg. 2007 Nov-Dec;16(6):735-41
references: 18029201