Managing bone loss on the humeral head

Introduction

A Hill-Sachs lesion (HSL), a compression fracture of the humeral head, is one of the most common findings seen in patients with recurrent anterior dislocation of the shoulder. We have proposed a concept of glenoid track to evaluate the risk of engagement between the HSL and the glenoid. If a HSL is extending medially over the medial margin of the glenoid track (off-track lesion), it needs to be treated. The prevalence of off-track lesions was demonstrated to be 7% in patients with recurrent anterior shoulder dislocations. There are various surgical procedures reported, but they can be categorized into two groups, direct and indirect methods ( Fig. 15.1 ). The direct method includes (1) filling of the humeral head defect by soft tissues (remplissage procedure), (2) filling of the humeral head defect by a bone graft (iliac crest, allograft), and (3) transhumeral elevation with supplemental graft (humeroplasty). The indirect method is to widen the glenoid track either by (1) widening the glenoid itself (Latarjet procedure, other types of bone graft to the glenoid) or (2) limiting the rotational range of motion (Putti-Platt, Weber osteotomy).