The dual subscapularis procedure: a modified Hawkins’ technique for neglected posterior fracture/dislocation of the shoulder
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Posterior fracture/dislocation of the shoulder is a rare injury that is frequently missed on initial assessment. It is frequently associated with reverse Hill–Sachs impression fracture. Several orthopaedics procedures have been described on the literature for reconstructable reverse Hill–Sachs lesion. The McLaughlin’s procedure and its modifications, anatomic bone grafting procedures, rotational osteotomies, and the remplissage technique were reported by many authors. We advocated a new “dual subscapularis procedure” that consists of the Hawkins lesser tuberosity transfer with addition of filling the remainder of the defect with a part of subscapularis tendon.
Materials and methods
In the period between January 2013 to December 2017, 12 patients (13 shoulders) suffering from a delayed managed posterior fracture dislocation were managed. Our inclusion criteria were adult patients less than 60 years presented with reverse Hill–Sachs impression defects from 20 to 50% with or without fractures. For all patients, the dual subscapularis procedure was done. UCLA score was used for postoperative functional assessment.
After a minimum follow-up of 6 months, the results of UCLA score were excellent/good in eight patients and fair/poor in five patients. All patients were found stable after open reduction ± internal fixation with no reported complications. There was a significant correlation of the UCLA score and non-abuse or lower doses of tramadol and the shorter interval between trauma and procedure. Twelve patients were satisfied after the operation.
Reconstructing the reverse Hill–Sachs defect with the dual subscapularis technique provides adequate stability, pain relief, and function in patients with locked chronic posterior shoulder fracture/dislocation. The used technique has the merit of versatility with different fracture patterns, improved fixation of the tendon and increasing the tendon’s footprint that ensures extra-articular location of the defect.
Level of evidence
KeywordsReverse Hill–Sachs Posterior shoulder dislocation Dual subscapularis procedure McLaughlin’s technique Hawkins’ technique Tramadol
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interests.
The study was approved by our local ethical committee and was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
All patients signed an informed consent after clear explanation of the surgical procedure.
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