Shoulder Dislocation, Reverse Bankart & Hill-Sachs Lesions
- While admitted on the floor, the patient declined reduction attempts without sedation and was successfully closed reduced in the OR.
- Humeral reconstruction was performed using an osteochondral allograft.
- The subscapularis was repaired to the lesser tuberosity footprint using two medial all-suture anchors and a lateral row of anchors.
January 16, 2026
5 min read
Source: Kevin Credille, MD; Jennifer Liu, MD; Patrick C. McCulloch, MD; and Joshua Woody, MD
Source: Kevin Credille,MD; Jennifer Liu,MD; Patrick C. McCulloch, MD; and Joshua Woody, MD
While admitted on the floor, the patient declined reduction attempts without sedation and was successfully closed reduced in the OR. She was seen by neurology to ensure optimal management of her epilepsy. After discharge,she was subsequently lost to follow-up and returned 4 months later with a locked posterior dislocation (Figure 5).
Source: Kevin Credille, MD; Jennifer Liu, MD; Patrick C. McCulloch, MD; and Joshua Woody, MD
source: Kevin Credille, MD; Jennifer Liu, MD; Patrick C. McCulloch, MD; and Joshua Woody, MD
Humeral reconstruction was performed using an osteochondral allograft. The appropriate sizing guide was selected to contain the defect. A guide pin was placed, and the recipient socket was reamed. The osteochondral allograft was sized, prepped and pulse irrigated to remove marrow elements on the back table. It was then press fit into the recipient socket with excellent purchase (Figure 9). Two standard headless compression screws were used to gain additional purchase given her seizure disorder. The shoulder was again taken through range of motion and found to be stable.
Source: Kevin Credille, MD; Jennifer Liu, MD; Patrick C. McCulloch,MD; and Joshua Woody,MD
The subscapularis was repaired to the lesser tuberosity footprint using two medial all-suture anchors and a lateral row of anchors. The incision was closed in layers in standard fashion.
postoperative course
Table of Contents
The patient has followed up at 1 month and 3 months without recurrent dislocation or complications. She has consistently engaged with physical therapy and adhered to her rehabilitation protocol.
Source: Kevin Credille, MD; Jennifer Liu, MD; Patrick C. McCulloch, MD; and Joshua Woody, MD
Three-month radiographs demonstrated maintained reduction, well-positioned grafts and no hardware failure (Figures 10 and 11). At the time of a humeral osteochondral allograft, as seen in this case, accomplished postoperative outcomes are achievable with appropriate patient selection, meticulous surgical technique and adherence to postoperative rehabilitation protocols.
Key points:
- Seizure-related posterior shoulder dislocations are more common due to the relative strength of internal rotators, frequently enough resulting in reverse Hill-Sachs lesions, posterior labral tears and reverse bony Bankart lesions.
- Posterior glenoid bone loss, even as small as 11%, increases recurrence risk, prompting consideration of posterior glenoid bony reconstruction.
- For defects of both the posterior glenoid and anterior humerus, dual allograft reconstruction with osteochondral allograft and distal tibial allograft can be a successful surgical option for the right patient.
For more information:
Kevin Credille, MD; Jennifer Liu, MD; Patrick McCulloch, MD; and Joshua T. Woody, MD, can be reached at Houston Methodist Hospital in Houston, Texas. Credille’s email: kcredille@houstonmethodist.org. Liu’s email: jwliu@houstonmethodist.org. McCulloch’s email: pcmcculloch@houstmethodist.org. Woody’s email: jtwoody@houstonmethodist.org.
Edited by Mitchell F. Bowers, MD, and Jennifer Liu, MD. Bowers is a chief resident in orthopedic surgery at Vanderbilt University Medical Center. He will be pursuing a spine surgery fellowship at the Leatherman Spine Institute following residency completion.Liu is a chief resident in orthopedic surgery at Houston Methodist Hospital. she will be pursuing an adult reconstruction fellowship at the University of California San Francisco following residency completion. For more information on submitting Orthopedics Today Grand Rounds cases, please email orthopedics@healio.com.
sources/Disclosures
Source:
Expert Submission
References:
Disclosures:
McCulloch reports being a paid consultant for and receiving research support from Arthrex, and being on the editorial or governing board for Orthobullets.com. Credille, Liu and Woody report no relevant financial disclosures.
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