Locked Anterior Dislocation

 

DisDis

 

Definition

 

A glenohumeral dislocation which has been missed for a significant period of time

- time period is arbitrary

- > 3-6 weeks

 

Pathology

 

Anterior glenoid bone deficiency

Large Hill Sachs lesions

Rotator cuff tears

 

Etiology

 

Poor historians

- developmental delay

- dementia

 

Issues

 

Closed reduction may be unsuccessful / locked

Open reduction - unstable due to bony deficiency / rotator cuff tears

 

Xray

 

Signs of chronic shoulder dislocation

 

disdisdis

 

CT

 

Assess bone stock / glenoid bone loss / Hill Sachs lesions

 

disdisdis

Chronic shoulder dislocation with large Hill Sachs and minimal glenoid deficiency

 

Ct disdis

Chronic shoulder dislocation with large Hill Sachs and significant glenoid deficiency

 

MRI

 

Rotator cuff tears

 

disdisdis

MRI with massive supraspinatus tear, subscapularis tear, and large Hill Sachs lesion

 

disdisdis

MRI with supraspinatus tear, Hill Sachs lesion and significant glenoid bony deficiency

 

Nonoperative management

 

Indications

 

Elderly with significant medial issues

 

Operative management

 

Options

 

1.  Reverse total shoulder arthroplasty +/- glenoid bone graft

2.  Open reduction +/- glenoid bone graft +/- Hill Sachs allograft +/- rotator cuff repair

 

Reverse TSA +/- glenoid bone graft

 

DisrTSArTSA

 

Open reduction +/- glenoid bone graft +/- Hill Sachs allograft +/- rotator cuff repair

 

Option 1:  Hill Sachs and glenoid allograft + rotator cuff repair

 

disdisdis

 

Option 2:  Humeral head replacement + glenoid autograft + rotator cuff repair

 

Locked Anterior 1Glenoid Reconstruction Humeral HeadGlenoid Reconstruction

 

Locked anterior surgery 1Locked anterior surgery 2Locked anterior surgery 3

Post humeral head replacement / glenoid autograft / rotator cuff repair

 

disdisdis

Rotator cuff failure and development of anterosuperior escape