PMC9903109_01
Preoperative computed tomography scan (axial
views) showing posteriorly locked dislocation with a reverse
Hill-Sachs lesion in 32% of the left shoulder and 36% of the
right shoulder.
JDRS-2023-34-1-226-233-F1.jpg
PMC9903109_01_JDRS-2023-34-1-226-233-F1.jpg
F1
The CT scan revealed a posteriorly locked dislocation with a reverse Hill-Sachs lesion in 32% of the left shoulder and 36% of the right shoulder (Figure 1). However, when we evaluated the available CT axial sections, we diagnosed bilateral LPSD with a reverse Hill-Sachs lesion in 32% of the left shoulder and 36% of the right shoulder (Figure 1).
With the patient in beach chair position the
intraoperative photograph was taken to demonstrate the
anterior aspect of the humeral head. Note the wedgeshaped impression fracture (black arrow) on the anterior
aspect of the humeral head.
JDRS-2023-34-1-226-233-F2.jpg
PMC9903109_01_JDRS-2023-34-1-226-233-F2.jpg
F2
After the glenohumeral joint was reduced, the arm was rotated outward to visualize the wedgeshaped Hill-Sachs lesion at the humeral head (Figure 2).
The intraoperative photograph was obtained with the patient in a beach chair position to show the
anterior side of the humeral head. Take note of the headless screws that run from the anterior to the posterior
of the humeral head to fix the transferred lesser tubercle to the remainder of the head, (a) two for the right and
(b)three for the left.
JDRS-2023-34-1-226-233-F3.jpg
PMC9903109_01_JDRS-2023-34-1-226-233-F3.jpg
F3
Under fluoroscopy, fixation was performed with headless screws (two for the right shoulder and three for the left shoulder; Figure 3a, b).
Postoperative anteroposterior radiograph of the shoulder showing that the shoulder is reduced and
the head has the expected hemispheric appearance. (a) Right, (b) Left.
JDRS-2023-34-1-226-233-F4.jpg
PMC9903109_01_JDRS-2023-34-1-226-233-F4.jpg
F4
Postoperative radiographs revealed a reduced shoulder and the expected hemispheric appearance of the head (Figure 4a, b).
Postoperative computed tomography scan (axial views) showing that the reverse Hill-Sachs lesion has completely filled and disappeared. (a) Right, (b) Left.
JDRS-2023-34-1-226-233-F5.jpg
PMC9903109_01_JDRS-2023-34-1-226-233-F5.jpg
F5
Postoperatively, the axial CT view indicated that the reverse Hill-Sachs lesion was entirely filled and disappeared (Figure 5a, b).
Postoperative follow-up photographs were taken from back, front and side views (at one-year follow-up
visit) showing shoulder function. From top to the bottom notice the internal rotation, forward elevation, abduction,
external rotation and forward elevation with external rotation.
JDRS-2023-34-1-226-233-F6.jpg
PMC9903109_01_JDRS-2023-34-1-226-233-F6.jpg
F6
The pre- and postoperative Constant-Murley Scores (CMS) for the right and left shoulder were 30/52 and 11/48, respectively (Figure 6).