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Arthroscopic-assisted treatment of a reversed hill-sachs lesion: description of a new technique using cerament.

Bark S, Renken F, Schulz AP, Paech A, Gille J - Case Rep Orthop (2015)

Bottom Line: Results.Conclusions.In conclusion, arthroscopic-assisted reconstruction of reversed Hill-Sachs lesions with an injectable bone substitute is feasible and may provide patients with all the benefits of an anatomic reconstruction with decreased risks related to open surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Reconstructive Surgery, University of Schleswig-Holstein, Campus Lübeck, Germany.

ABSTRACT
Purpose. Impaction fractures of the anterior aspect of the humeral head, the reversed Hill-Sachs lesion, are common in posterior shoulder dislocation. We present a new technique to address these lesions arthroscopic-assisted with the use of a bone substitute. Methods. We report the case of a 45-year-old male with a reversed Hill-Sachs lesion after posterior shoulder dislocation. Initially a glenohumeral arthroscopy is performed to address concomitant intra-articular injuries. Guided by the k-wire a cannulated sizer was inserted for reduction of the fracture under arthroscopic visualization. For reduction of the impacted part of the humeral head the subcortical defect was filled with an injectable bone substitute (Cerament) to prevent secondary dislocation. Results. X-ray at follow-up 6 months after the index procedure documents the bony remodeling of the bone substitute. At that time the patient was pain-free (VAS 0) and satisfied with the outcome (Constant score: 78, Rand-36 score: 84, Rowe score: 81) with a good ROM. Conclusions. In conclusion, arthroscopic-assisted reconstruction of reversed Hill-Sachs lesions with an injectable bone substitute is feasible and may provide patients with all the benefits of an anatomic reconstruction with decreased risks related to open surgery.

No MeSH data available.


Related in: MedlinePlus

Fluoroscopic visualization during the index procedure. Guided by the k-wire a cannulated sizer (8 mm diameter, BioMatrix CRD instruments, Arthrex) was inserted for reduction of the fracture under arthroscopic visualization.
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fig3: Fluoroscopic visualization during the index procedure. Guided by the k-wire a cannulated sizer (8 mm diameter, BioMatrix CRD instruments, Arthrex) was inserted for reduction of the fracture under arthroscopic visualization.

Mentions: The patient was placed in beach chair position with an image intensifier perpendicular to the patient's axis from the contralateral side to allow arthroscopy and radiographs simultaneously. Under general anaesthesia, a closed reduction of the glenohumeral joint was performed and standard arthroscopic portals were placed. At the anteromedial humeral head the reversed Hill-Sachs lesion was visualized (Figure 4(a)); the findings were in accordance with the preoperative X-rays and CT scans (Figure 1). No more injuries were found in the anterior shoulder region with an intact tendon of the subscapularis, the biceps brachii tendon, and an intact labrum. Through a lateral approach a k-wire was placed into the central defect of the Hill-Sachs lesion (Figure 2); it can be helpful to guide the k-wire by a tibial guide used in cruciate ligament surgery (Arthrex, USA). Guided by the k-wire a cannulated sizer (8 mm diameter, BioMatrix CRD instruments, Arthrex) was inserted for reduction of the fracture under arthroscopic visualization (Figure 3). For internal fixation the subcortical defect was filled with an injectable bone substitute (Cerament) to prevent secondary dislocation. After hardening of the bone substitute the reconstruction of the humeral head was documented by arthroscopy (Figure 4(b)). Wounds were closed and the portals were covered with sterile dressings.


Arthroscopic-assisted treatment of a reversed hill-sachs lesion: description of a new technique using cerament.

Bark S, Renken F, Schulz AP, Paech A, Gille J - Case Rep Orthop (2015)

Fluoroscopic visualization during the index procedure. Guided by the k-wire a cannulated sizer (8 mm diameter, BioMatrix CRD instruments, Arthrex) was inserted for reduction of the fracture under arthroscopic visualization.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4321679&req=5

fig3: Fluoroscopic visualization during the index procedure. Guided by the k-wire a cannulated sizer (8 mm diameter, BioMatrix CRD instruments, Arthrex) was inserted for reduction of the fracture under arthroscopic visualization.
Mentions: The patient was placed in beach chair position with an image intensifier perpendicular to the patient's axis from the contralateral side to allow arthroscopy and radiographs simultaneously. Under general anaesthesia, a closed reduction of the glenohumeral joint was performed and standard arthroscopic portals were placed. At the anteromedial humeral head the reversed Hill-Sachs lesion was visualized (Figure 4(a)); the findings were in accordance with the preoperative X-rays and CT scans (Figure 1). No more injuries were found in the anterior shoulder region with an intact tendon of the subscapularis, the biceps brachii tendon, and an intact labrum. Through a lateral approach a k-wire was placed into the central defect of the Hill-Sachs lesion (Figure 2); it can be helpful to guide the k-wire by a tibial guide used in cruciate ligament surgery (Arthrex, USA). Guided by the k-wire a cannulated sizer (8 mm diameter, BioMatrix CRD instruments, Arthrex) was inserted for reduction of the fracture under arthroscopic visualization (Figure 3). For internal fixation the subcortical defect was filled with an injectable bone substitute (Cerament) to prevent secondary dislocation. After hardening of the bone substitute the reconstruction of the humeral head was documented by arthroscopy (Figure 4(b)). Wounds were closed and the portals were covered with sterile dressings.

Bottom Line: Results.Conclusions.In conclusion, arthroscopic-assisted reconstruction of reversed Hill-Sachs lesions with an injectable bone substitute is feasible and may provide patients with all the benefits of an anatomic reconstruction with decreased risks related to open surgery.

View Article: PubMed Central - PubMed

Affiliation: Department of Trauma and Reconstructive Surgery, University of Schleswig-Holstein, Campus Lübeck, Germany.

ABSTRACT
Purpose. Impaction fractures of the anterior aspect of the humeral head, the reversed Hill-Sachs lesion, are common in posterior shoulder dislocation. We present a new technique to address these lesions arthroscopic-assisted with the use of a bone substitute. Methods. We report the case of a 45-year-old male with a reversed Hill-Sachs lesion after posterior shoulder dislocation. Initially a glenohumeral arthroscopy is performed to address concomitant intra-articular injuries. Guided by the k-wire a cannulated sizer was inserted for reduction of the fracture under arthroscopic visualization. For reduction of the impacted part of the humeral head the subcortical defect was filled with an injectable bone substitute (Cerament) to prevent secondary dislocation. Results. X-ray at follow-up 6 months after the index procedure documents the bony remodeling of the bone substitute. At that time the patient was pain-free (VAS 0) and satisfied with the outcome (Constant score: 78, Rand-36 score: 84, Rowe score: 81) with a good ROM. Conclusions. In conclusion, arthroscopic-assisted reconstruction of reversed Hill-Sachs lesions with an injectable bone substitute is feasible and may provide patients with all the benefits of an anatomic reconstruction with decreased risks related to open surgery.

No MeSH data available.


Related in: MedlinePlus