Modified McLaughlin procedure combined with proximal humeral locking plate for proximal humeral fractures with posterior shoulder dislocation and reverse Hill-Sachs lesion: a retrospective case series.

OBJECTIVE

Proximal humeral fractures with posterior shoulder dislocation are rare, high-energy injuries that pose significant treatment challenges. This study aimed to evaluate the clinical application and short-term outcomes of a combined surgical technique utilizing the modified McLaughlin procedure with a proximal humeral locking plate for such complex injuries.

METHODS

A retrospective case series was conducted on 9 patients with proximal humeral fractures and posterior shoulder dislocation treated at our hospital from March 2019 to September 2024. All patients underwent combined surgical treatment: structural bone grafting using a pedicled lesser tuberosity fragment, fixed with independent cannulated screw under compression to reconstruct the reverse Hill-Sachs defect, along with fixation of the humeral fracture using a proximal humeral locking plate. Perioperative parameters were recorded, and Visual Analog Scale (VAS), University of California, Los Angeles (UCLA) Shoulder Rating Scale, Constant-Murley scores, shoulder range of motion (ROM), and Limb Symmetry Index(LSI) were assessed at the 1-year postoperative follow-up.

RESULTS

All 9 patients completed a mean follow-up of 15.1 months. The median VAS score was 0, the median UCLA score was 32, and the median Constant-Murley score was 86. Shoulder ROM recovery was satisfactory, with median active forward flexion, abduction, external rotation, and internal rotation measuring 155°, 145°, 60°, and 65°, respectively. No cases of redislocation, implant failure, or avascular necrosis of the humeral head occurred.

CONCLUSION

For patients with proximal humeral fractures and posterior shoulder dislocation involving a reverse Hill-Sachs defect occupying 25%-40% of the articular surface, treatment with the combined surgical technique of modified McLaughlin procedure combined with locking plate fixation effectively restores shoulder anatomy, results in minimal postoperative pain, and achieves satisfactory functional recovery. This constitutes a reliable treatment option for such complex injuries.

LEVEL OF EVIDENCE: IV (Retrospective Case Series).