PMC5427706_01
Anteroposterior view of the right shoulder showing anterior dislocation with impaction of the humeral head (Hill-Sachs lesion) and associated comminuted greater tuberosity fracture.
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F1
Radiological examination showed an anterior shoulder dislocation with impaction of the humeral head underneath glenoid and associated fracture of the greater tuberosity (Fig. 1).
Intraoperative view of the dislocation through the dectopectoral approach. The thin arrow shows the impaction of the humeral head underneath glenoid rim, the small arrow the interposed long head of the biceps tendon and the star the greater tuberosity fragment. The drawing at the right illustrates the intraoperative findings.
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F2
Open reduction was accomplished thereafter using the deltopectoral approach; the biceps tendon was found entrapped posterolateral between the humeral head and the tuberosity fragment preventing once again reduction of the glenohumeral joint. (Fig. 2).
Postoperative anteroposterior view of the right shoulder showing reduction of the dislocation and fixation of the greater tuberosity with transosseous sutures. The bone anchor indicates the site of biceps tendon tenodesis.
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F3
The greater tuberosity was fixed back to its bed using heavy transosseous sutures (Fig. 3).
Follow up anteroposterior x-ray of the right shoulder in external (a) internal (b) and rotation showing a stable joint and good healing of the greater tuberosity.
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F4
At the last follow up, one year postoperatively he had a stable joint, full range of motion and a Constant score of 90 (Fig. 4).