Chronic locked posterior gleno-humeral dislocation: technical note on fibular grafting for restoration of humeral head sphericity

• Published in: Journal of orthopaedic surgery and research Vol. 16; no. 1; p. 683
• Main Author: Kandeel, Amr Abdel-Mordy
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 18-11-2021; BioMed Central; BMC
• Subjects: Autografts; Bone Transplantation - methods; Cartilage (articular); Chronic Disease; Debridement; Disease transmission; Dissection; Familiarity; Fibula - transplantation; Fibular grafting; Humans; Humeral Head - diagnostic imaging; Humeral Head - surgery; Humeral head reconstruction; Humerus; Joint Instability - surgery; Locked gleno-humeral dislocation; Medical research; Medicine, Experimental; Open Fracture Reduction - methods; Orthopedics; Posterior gleno-humeral dislocation; Range of motion; Range of Motion, Articular; Reproducibility of Results; Reverse Hill-Sachs defect; Risk assessment; Shoulder Dislocation - diagnostic imaging; Shoulder Dislocation - rehabilitation; Shoulder Dislocation - surgery; Shoulder Joint - surgery; Technical Note; Tendons; Transplantation of organs, tissues, etc; Transplantation, Autologous; Fibular grafting; Reverse Hill-Sachs defect; Posterior gleno-humeral dislocation; Humeral head reconstruction; Locked gleno-humeral dislocation
• ISSN: 1749-799X; 1749-799X
• DOI: 10.1186/s13018-021-02835-2

Reconstruction of reverse Hill-Sachs defect using osteo-chondral allograft has the advantages of spherical re-contouring and provision of smooth biological articular surface of the reconstructed humeral head. However, worldwide availability and risk of disease transmission of osteo-chondral allograft remain points of increasing concerns. As an alternative to lacking osteo-chondral allograft, the current technical note describes a reconstructive technique of reverse Hill-Sachs defect using autologous fibular grafting.
Following open reduction of the dislocated humeral head, reverse Hill-Sachs defect was reconstructed using 3-4 autologous fibular pieces (each is of 10 mm in length) fixed in flush with the articular cartilage using 4-mm cancellous screws. Defect reconstruction was then followed by modified McLaughlin's transfer and posterior capsulorrhaphy.
Spherical contour of the humeral head and gleno-humeral range of motion were restored. Intra-operative dynamic testing of the reconstruct revealed no residual posterior gleno-humeral instability.
Currently reported technique might offer advantages of graft availability, technical simplicity, familiarity and reproducibility, safety (i.e. no disease transmission) and bone preservation facilitating future revision management (if needed). Nevertheless, long-term outcomes of this technique should be investigated via further cohort clinical studies.