Modified McLaughlin technique for neglected locked posterior dislocation of the shoulder.

Several surgical techniques have been described for the treatment of posterior shoulder dislocation depending on the time elapsed between injury and surgery and the size of the humeral head impression fracture. When the bone defect is between 25% and 50% of the articular surface of the head, the procedures of choice are autologous bone graft or allograft or subscapularis tendon or lesser tuberosity transfer. In neglected cases in which patients undergo surgery more than 3 weeks after injury, no standard accepted treatment for this injury exists. This article presents a modification of the McLaughlin technique for patients with neglected locked posterior dislocation of the shoulder. Using this technique, the shape of the humeral head was nearly restored with impaction of morselized bone allograft; two suture anchors were inserted into the defect, and the lesser tuberosity with the attached sub-scapularis tendon was transferred into the defect and secured with sutures. Postoperative rehabilitation included immobilization of the shoulder with an external rotation brace for 6 weeks followed by progressive passive, active-assisted, and active range of motion and rotator cuff strengthening exercises for another 6 weeks. This technique resulted in pain-free range of motion, a stable shoulder, and good joint congruency.