Elsevier

Injury

Volume 44, Issue 4, April 2013, Pages 488-491
Injury

Long-term follow-up of allograft reconstruction of segmental defects of the humeral head associated with posterior dislocation of the shoulder

https://doi.org/10.1016/j.injury.2012.10.027Get rights and content

Abstract

The purpose of this study is to report the long-term follow-up result of allograft reconstruction of segmental defect of the humeral head associated with posterior dislocation of the shoulder.

Six men underwent operative management of defects of the humeral head involving 40% of the articular surface, following posterior dislocation of the humeral head. The period of time between dislocation and surgery ranged from 7 to 8 weeks. The defect in the head was filled with an allogeneic segment of humeral head contoured to restore the spherical shape. All the patients returned to their occupation 4 months later. All the cases were evaluated clinically and by radiographs and computed tomography (CT) scan at a mean of 122 (96–144) months after the operative procedure. Three men had no complaints of pain, instability, clicking or catching, whereas three had pain, clicking, catching and stiffness. The three patients with good clinical result showed also good radiographic result. The computed tomography (CT) confirmed incorporation of the allograft and no osteoarthrosis. Another patient had a good clinical and radiographic result until the eighth postoperative year. At 8-year follow-up examination, this patient developed shoulder osteoarthrosis and he had pain and stiffness. He needed an arthroplasty 10 years after the operation. The other two patients developed collapse of the graft and osteoarthrosis that were yet evident at 4-year follow-up. These patients required a shoulder arthroplasty 8 years after the procedure.

We conclude that the treatment of segmental defects of the humeral head associated with posterior dislocations of the shoulder by allograft reconstruction has a good long-term follow-up result in 50% of the patients.

Section snippets

Materials and methods

Between 1998 and 2002, six men underwent operative management of defects of the humeral head that involved 40% of the articular surface, following posterior dislocation of the humeral head. None of the men had a previous history of shoulder disorder. The cause of the dislocation was a grand mal seizure in three cases and a fall in three cases. For five patients, the dislocation was reduced under general anaesthesia. A computed tomography (CT) scan was performed after reduction to evaluate the

Results

We had no early or late infections, non-unions at the graft–host junction or joint instability. All the patients returned to their occupation 4 months after surgery. All the cases were evaluated clinically and by radiographs and CT scan at a mean of 122 (96–144) months after the operative procedure. Three men had no complaints of pain, instability, clicking or catching, whereas three had pain, clicking, catching and stiffness. The range of motion and the Constant score at the last follow-up

Discussion

Our study shows the long-term result of an anatomic repair with allograft as a treatment for impression fractures associated with posterior shoulder dislocation. We obtained good results in three patients and poor in other three. Of the three patients with poor results, one developed shoulder arthrosis at 8-year follow-up and the other two developed collapse of the graft and osteoarthrosis at 4-year follow-up.

The experience of several authors3, 4, 10 in chronic posterior dislocations of the

Conclusion

We think that the treatment of segmental defects of the humeral head associated with posterior dislocations of the shoulder by allograft reconstruction represents a viable technical choice, with a good long-term follow-up result in 50% of the patients.

Conflict of interest

We have no conflict of interest.

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