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Locked Post. Shoulder Disloc

Locked posterior dislocation of shoulder – case report.

Surgeon:
Mr.K.R.Rajesh,MS (Orth) ,Dip NB (Orth) ,FRCS, FRCS(Orth)
Consultant Upper Limb Surgeon, Division of Upper Limb & Joint Replacement Surgery.
Cosmopolitan Hospital, Trivandrum,Kerala,
India.
Mobile-9447191205

28 yr old  right hand dominant man sustained an electrical shock 9 months previously in a village. He developed restriction of movement in the right shoulder immediately after the incident and underwent the usual indigenous treatment involving massage and oil application. He came to the clinic with pain and loss of  movements in the right shoulder. He used to work as a mason but had not been able to work since the injury.

On examination he had  an internal rotation deformity in the right shoulder. He had some degree of scapulothoracic movements. His elbow movements were free as was his wrist and hand function. He had no axillary nerve injury.

Xrays confirmed an unreduced posterior dislocation on the right side.

AP view showing the dislocation

Scapular lateral view showing the head posterior to the glenoid.

CT scan with 3D reconstructions showed that there was a defect in the head (reverse Hill-Sach lesion) and that the glenoid was locked into the defect. The articular surface was completely rotated and faced posteriorly.

CT scan showing the defect with the glenoid locking into it.

3D CT view from the front.

3D CT view from the back

He underwent an open reduction through a deltopectoral approach (plus a mini open posterior approach ) The defect in the anterior part of the head was vertically oriented and just lateral to the articular surface.( 7cm x 3 cm x 2 cm) The head readily dislocated on minimal internal rotation. A tricortical bone graft was obtained from the ipsilateral iliac crest to exactly fill the defect and was fixed using two 4mm cancellous screws. The head continued to be unstable and so a derotation osteotomy was done in order to prevent the head from reaching the position of instability. The osteotomy was fixed using  a 4.5 DCP. A thick K wire was used to transfix the head to the glenoid temporarily ( will be removed in 2-3 weeks).

Subscapularis was repaired. The shoulder was immobilized in an immobiliser with elbow in flexion.

View from the front. Large defect just lateral to the articular margin which is to the right of the image.

Immediate postoperative Xray. Note the  4mm cancellous screws fixing the graft in the defect and the transfixing Kwire. (Osteotomy fixation not included in this xray)



Dr Rajesh can be contacted on [email protected]

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