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Open Reduction and Posterior Capsular Shift for Cases of Neglected Unreduced Posterior Shoulder Dislocation

From the Orthopedic Department, Cairo University, Cairo, Egypt

^* Address correspondence to Mohamed Taha El Shewy, MD, Orthopedic Department, Cairo University, 51 B Demascus St, Dokki, Cairo, Egypt 12411 (e-mail: mshewy{at}gmail.com).

Background: Neglected unreduced posterior shoulder dislocation is a challenging orthopaedic problem.

Purpose: To evaluate the results of open reduction with posterior cruciate capsular repair for such cases. This corrects the wide posterior capsule, which is the main pathologic entity.

Study Design: Case series; Level of evidence, 4.

Methods: Over a period of 5 years, 17 patients with unreduced neglected posterior shoulder dislocation with an impression fracture involving less than 25% of the humeral head were treated by open reduction together with posterior cruciate capsular repair as described by Neer. The patients’ average age was 48.5 years (range, 32.5–66 years). There were 14 men and 3 women. The dominant shoulder was affected in 14 cases.

Results: After a minimum follow-up of 5 years (range, 5–10 years), the average UCLA score improved from 18 preoperatively to 33 postoperatively. The average modified Rowe score changed from 42.2 to 78.4 points. The American Shoulder and Elbow Surgeons Shoulder score showed an average of 40.3 points preoperatively and an average of 79.8 points at final follow-up. Three patients developed late osteoarthritic changes. Two had changes of mild degree, and 1 needed a total shoulder replacement.

Conclusion: Open reduction with posterior cruciate capsular repair offers a good solution for the problem of neglected unreduced posterior shoulder dislocation excluding cases with osteoarthritic changes and those with impression fracture involving less than 25% of the head.

Key Words: neglected posterior dislocation • open reduction • capsular repair • long-term follow-up