Management of a posterior locked fracture dislocation

A 55 year old triathlete fell while bike riding, landing on his outstretched left hand. He developed posterior instability that was treated with a posterior arthroscopic stabilization at an outside facility. Subsequently it was noted that he had developed a locked posterior fracture dislocation with both an anterior humeral and a posterior glenoid defect as shown by the images below.

He elected an open reduction and humeral hemiarthroplasty with an anteriorly eccentric humeral head and a posterior glenoid bone graft using part of the resected humeral head. At surgery his shoulder was very stable under vigorous posterior loading.

The postoperative films are shown below

The plan is for external rotation isometrics and 6 weeks immobilization in a neutral rotation brace.
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Consultation for those who live a distance away from Seattle.

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Information about shoulder exercises can be found at this link.

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

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Reverse total shoulder for locked fracture dislocation - an issue of glenoid bone deficiency

Reverse arthroplasty for patients with chronic locked dislocation of the shoulder (type 2 fracture sequela) 

These authors reviewed 22 patients (mean age 71 years) with chronic locked fracture dislocations.

While there was a significant increase in comfort and function, there were 7 complications (32%), leading to revision surgery in 6 cases (27%). The most common reason (4 cases) for revision surgery
was failure of the glenoid component due to bone defects on the glenoid side. In each case, a large defect of the anterior glenoid was treated with an augmentation using bone from the humeral head to restore the bony anatomy. In each case, the 15-mm central peg of the glenoid baseplate was inserted only partially into the native glenoid bone. The failures occurred after 1 week, 1 month, 9 months, and 2 years.
Revision surgery was performed in all cases, consisting of removal of the glenoid implant and conversion to hemiarthroplasty with a large head designed for cuff tear arthropathy. Of these 4 patients, 3 rated their result as unsatisfying.  Another patient had 2 dislocations of the implant during the first postoperative week. One other patient had a fracture of the humerus due to a fall and another patient had a late infection 3 years after surgery.

Here is one of their examples of the problem

The axillary view shows major glenoid bone loss.

Screw fixation of the glenoid was compromised by the glenoid bone loss.

 And the baseplate became loose.

The authors have demonstrated that glenoid bone grafting may be helpful in such cases but emphasize the importance of fixing the baseplate to native bone.

Comment: In a prior post A difficult combination: simultaneous humeral head and glenoid defects
we showed the difficulty in attempting to manage glenoid defects with an anatomic arthroplasty.

We've posted some thoughts on the management of glenoid bone defects here:

Reverse total shoulder - managing glenoid bone defects

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Consultation for those who live a distance away from Seattle.

Click here to see the new Shoulder Arthritis Book.

Click here to see the new Rotator Cuff Book

Information about shoulder exercises can be found at this link.

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

See from which cities our patients come.

See the countries from which our readers come on this post.

A difficult combination: simultaneous humeral head and glenoid defects

We were recently sent the x-rays from the right shoulder of a young person with a shoulder injury. While the AP view appeared to show arthritis.

the axillary 'truth' view showed a posterior fracture dislocation with major loss of anterior humeral bone and posterior glenoid bone.

A CT scan added no additional information

He was treated with a hemiarthroplasty

After an early post operative injury, an axillary view was taken showing displacement of the prosthetic humeral head into the posterior glenoid defect.

We not confident that any surgical procedure will meet the needs of this young active person. In our experience a posterior bone graft is unlikely to withstand the loads that will be put on it by the hemiarthroplasty. A reverse total shoulder could be considered using the residual anterior glenoid bone, but this approach may not be appropriate for a young person with high activity expectations.

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Consultation for those who live a distance away from Seattle.

Click here to see the new Shoulder Arthritis Book.

Click here to see the new Rotator Cuff Book

Information about shoulder exercises can be found at this link.

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and run, reverse total shoulder, CTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'

See from which cities our patients come.

See the countries from which our readers come on this post.