Main Article Content
locked posterior fracture-dislocation of the shoulder (LPFDS),, trans-deltoid lateral approach, Shantz pins, locking plate
Background and aim of the work: To describe a valid option for the treatment of locked posterior fracture-dislocation of the shoulder (LPFDS) and to compare it to the literature about this topic. Methods: We present a small case series (3 patients), with a medium follow up at 4 years and 5 months. We accurately describe our surgical strategies, underlining the choice of approach, reduction and fixation. Results: The three patients showed excellent functional and radiological results at the follow up examinations, with a full range of shoulder movements and complete regain of pre-trauma activities. A lateral approach (standard or minimally invasive), a reduction technique with a Shantz pin in the head and in the humeral shaft, and fixation with a locking plate were used in the three patients. Conclusion: LPFDS is a challenging lesion, hard to recognize and to treat. Our suggested method of treatment is highly reproducible and has revealed itself to be very effective in achieving good results.
shoulder: report of two cases. Int J Shoulder Surg 2009; 3: 41–5.
2. Ivkovic A, Boric I and Cicak N. One-stage operation for locked bilateral posterior
dislocation of the shoulder. J Bone Joint Surg Br 2007; 89: 825–8.
3. Robinson CM, Aderinto J. Posterior shoulder dislocations and fracture dislocations.
J Bone Joint Surg Am. 2005;87:639-50
4. Basal O, Dincer R, Turk B. Locked posterior dislocation of the shoulder: A
systematic review. EFORT Open Rev. 2018 Jan 15;3(1):15-23.
5. Altan E, Senaran H, Acar MA et al. Mozaicplasty technique for treatment of reverse
Hill-Sachs lesion. Tech Shoulder Elbow Surg 2013;14:1-4.
6. Shams A, El-Sayed M, Gamal O et al. Modified technique for reconstructing reverse
Hill-Sachs lesion in locked chronic posterior shoulder dislocation. Eur J Orthop
Surg Traumatol 2016;26:843-849
7. Neer CS. Displaced proximal humeral fractures. I. Classification and evaluation. J
Bone Joint Surg Am 1970; 52: 1077–89.
8. Neer CS. Displaced proximal humeral fractures. II. Treatment of three-part and
four-part displacement. J Bone Joint Surg Am 1970; 52: 1090–103.
9. Sheehan SE, Gaviola G, Sacks A, et al. Traumatic shoulder injuries: a force
mechanism analysis of complex injuries to the shoulder girdle and proximal
humerus. AJR Am J Roentgenol. 2013;201:W409–W424
10. Robinson CM, Akhtar A, Mitchell M et al. Complex posterior fracture-dislocation
of the shoulder. Epidemiology, injury patterns, and results of operative treatment. J
Bone Joint Surg Am. 2007;89(7):1454-66.
11. Kokkalis ZT, Iliopoulos ID, Antoniou G, et al. Posterior shoulder fracture
dislocation: an update with treatment algorithm. Eur J Orthop Surg Traumatol.
12. Gokkus K, Sagtas E, Kara H et al. Posterior Shoulder Dislocation Associated With
the Head (Splitting) and Humeral Neck Fracture: Impact of Understanding
Radiologic Signs and Experience With an Extended Deltopectoral Approach. Tech
Hand Up Extrem Surg. 2018 Jun;22(2):57-64.
13. Chesser TJ, Langdon IJ, Ogilvie C, et al. Fractures involving splitting of the
humeral head. J Bone Joint Surg Br. 2001;83:423–426
14. Kokkalis ZT, Mavrogenis AF, Ballas EG et al. Modified McLaughlin technique for
neglected locked posterior dislocation of the shoulder. Orthopedics 2013;36:e912
15. Martinez AA, Navarro E, Iglesias D et al. Long-term follow-up of allograft
reconstruction of segmental defects of the humeral head associated with posterior
dislocation of the shoulder. Injury 2013;44:488-491.
16. Hawkins RJ, Switlyk P. Acute prosthetic replacement for severe fractures of the
proximal humerus. Clin Orthop Relat Res. 1993;289:156-60
17. Wijgman AJ, Roolker W, Patt TW et al. Open reduction and internal fixation of
three and four-part fractures of the proximal part of the humerus. J Bone Joint Surg
18. Boileau P, Krishnan SG, Tinsi L et al. Tuberosity malposition and migration:
reasons for poor outcomes after hemiarthroplasty for displaced fractures of the
proximal humerus. J Shoulder Elbow Surg. 2002;11:401-12
19. Kralinger F, Schwaiger R, Wambacher M et al. Outcome after primary
hemiarthroplasty for fracture of the head of the humerus. A retrospective multicentre
study of 167 patients. J Bone Joint Surg Br. 2004;86:217-9.
20. Stableforth PG, Sarangi PP. Posterior fracture-dislocation of the shoulder. A
superior subacromial approach for open reduction. J Bone Joint Surg Br. 1992
21. Fiorentino G, Cepparulo R, Lunini E et al. A Posterior shoulder fracture-dislocation:
double approach treatment. Our experience.. Acta Biomed. 2016 13;87(2):184-90
22. Waqar S, Puneet M. Open Reduction and Internal Fixation of Posterior Fracture
Dislocation of the Shoulder Made Easy!. J Orthop Case Rep. 2017; 7(6): 24–26.
23. Shin YH, Lee YH, Choi HS, et al. A modified deltoid splitting approach with
axillary nerve bundle mobilization for proximal humeral fracture fixation. Injury.
24. Laux CJ, Grubhofer F, Werner CML et al. Current concepts in locking plate fixation
of proximal humerus fractures. J Orthop Surg Res. 2017 25;12(1):137.
25. Jabran A, Peach C, Zou Z et al. Biomechanical comparison of screw-based zoning
of PHILOS and Fx proximal humerus plates. BMC Musculoskelet Disord. 2018 Jul
26. Gavaskar AS, Karthik BB, Tummala NC et al. Second generation locked plating for
complex proximal humerus fractures in very elderly patients. Injury.
27. Cheng SL, Mackay MB, Richards RR. Treatment of locked posterior fracture
dislocations of the shoulder by total shoulder arthroplasty. J Shoulder Elbow Surg