title: Long-term outcome of segmental reconstruction of the humeral head for the treatment of locked posterior dislocation of the shoulder.
abstract: BACKGROUND
  Locked posterior glenohumeral dislocations with impaction fractures involving less than 30% to 35% of the humeral head are most frequently treated with lesser tuberosity transfer into the defect, whereas those involving more than 35% to 40% are treated with humeral head arthroplasty. As an alternative, reconstruction of the defect with segmental femoral or humeral head allograft has been proposed, but the long-term outcome of this joint-preserving procedure is unknown.
  
  
  METHODS
  Twenty-two shoulders in 21 patients with a locked posterior shoulder dislocation and an impaction of at least 30% (mean, 43%) of the humeral head were treated with segmental reconstruction of the humeral head defect. They were reviewed clinically and radiographically at a minimum follow-up of 5 years.
  
  
  RESULTS
  Of the 22 shoulders, 19 could be followed up at 128 months (range, 60-294 months) postoperatively. Only 2 of the 19 patients needed a prosthesis more than 180 months after the index operation. Of the other 17, 4 had radiographically advanced osteoarthritis (OA), 4 had mild OA, and 9 had no or minimal OA. Eighteen shoulders were rated as subjectively excellent, none were rated as good, and one was rated as fair. The final Constant-Murley score averaged 77 points (range, 52-98 points), the Subjective Shoulder Value averaged 88% (range, 75%-100%), and only 2 patients had mild to moderate pain. Mean active anterior elevation was 145°, and mean external rotation with the arm at the side was 42°.
  
  
  CONCLUSIONS
  Segmental reconstruction of humeral head defects for large anteromedial impaction fractures caused by locked posterior dislocations durably restores stability and freedom from pain with an excellent subjective long-term outcome.
authors.affiliation: Department of Orthopaedics, University of Zürich, Balgrist University Hospital, Zürich, Switzerland. Electronic address: christian.gerber@balgrist.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Gerber
authors.affiliation: Department of Orthopaedics, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Catanzaro
authors.affiliation: Department of Orthopaedics, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Michele
authors.initials: M
authors.lastname: Jundt-Ecker
authors.affiliation: Department of Orthopaedics, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.
authors.forename: Mazda
authors.initials: M
authors.lastname: Farshad
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D058430:Humeral Head / Q000293:injuries / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012783:Shoulder Dislocation / Q000150:complications / Q000601:surgery*; D012784:Shoulder Fractures / Q000150:complications / Q000601:surgery*; D012785:Shoulder Joint / Q000601:surgery*; D016896:Treatment Outcome
keywords: Segmental reconstruction; humeral head; locked posterior dislocation; long-term