Surgical management of chronic, unreduced posterior dislocation of the shoulder

Four patients with chronic posterior dislocation of the shoulder underwent surgical treatment after an average delay of 10 months from injury. They were examined clinically and radiographically at an average follow-up of 32 months. Treatment consisted of subscapularis tendon transfer (McLaughlin procedure) into the humeral defect in one case, transfer of the lesser tuberosity (McLaughlin modified procedure) in two cases, and in the fourth case-a patient with a 19-month missed dislocation and 50% humeral head lesion-a transposition of the coracoid process and conjoined tendon was performed. X-rays and CT scan excluded avascular necrosis or severe post-traumatic arthrosis. All patients achieved complete pain relief without limitation of daily or work activities. A slight limitation of anterior elevation and external rotation was present in all patients. Our results confirm that McLaughlin's original or modified procedure is suggested in cases of chronic, unreduced posterior dislocation of the shoulder (type I according to Randelli). The transposition of the coracoid process is a valid alternative to prosthesis and to autologous or homologous bone graft implants.