A 40-year-old woman sustains a posterior shoulder dislocation after an epileptic seizure. She presents 3 weeks later with restricted shoulder internal rotation. Radiograph shows a 'trough line' sign and 'rim sign'. The posterior dislocation involves an impaction defect of the anterior humeral head. When the Hill-Sachs equivalent (reverse Hill-Sachs) involves >40% of the humeral head articular surface, the most appropriate treatment is:

• A Humeral head replacement (hemiarthroplasty or TSA) ✓
• B Closed reduction under general anaesthesia
• C McLaughlin procedure (subscapularis tenodesis into the defect)
• D Posterior capsular plication

Explanation

A reverse Hill-Sachs lesion (impaction fracture of the anterior humeral head from the posterior glenoid rim) after posterior dislocation requires staged management based on defect size. Defects <20% can be managed with closed reduction; 20–40% are treated by McLaughlin procedure (subscapularis tenodesis or bone block filling the defect to prevent re-dislocation); >40% defects involve too much of the articular surface to be reconstructed and are best treated by humeral head replacement (hemiarthroplasty or, preferably, total shoulder arthroplasty) if the glenoid is intact and the patient is chronologically suitable.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.