Locked posterior dislocation of shoulder: A reiteration of Mclaughlin’s procedure, reassessing the relevance after seven decades- a case report

Background: Posterior shoulder dislocation is rare (0.6 % per 100,000 population), often associated with defects in the humeral head. Management varies by the percentage of articular cartilage involvement, especially for defects with 25–50 % are challenging due to unclear guidelines. Many procedures are described in the literature including bone grafting, rotational osteotomies and arthroscopic remplissage since then. In our report, we reassessed the McLaughlins procedure without labral repair to evaluate its significance and compared it with other methods in existing literature. Case report: A 45-year-old male with no co-morbidities presented in our orthopaedic OPD with h/o RTA and fall on outstretched hand, complaining of right shoulder pain. X-ray showed no obvious abnormality and was treated conservatively. After one month the patient came with complaints of pain, stiffness, and restriction of movement at the right shoulder. CT and MRI showed Glenohumeral malalignment with posteriorly dislocated humeral head associated with chip fracture of inferior glenoid rim and impaction fracture in the anteromedial humeral head measuring 34 % of the articular surface. Intervention: We treated the patient with McLaughlins procedure without repairing the posterior labrum, using single anchor parachute technique through open deltopectoral approach. Post-operatively the patient was reviewed at 4 weeks, 6,9, 12 and 18 months and the outcome was assessed using DASH score and pain using Numerical Visual analogue scale at rest and at activity. Outcome: There was statistically significant improvement in the DASH score in 4 weeks, 6 and 9 months with better tolerance of pain in activity, with no complications and instability till 18 months. Conclusion: Early identification and planning can create marked improvement in outcome. Subscapularis remplissage without labral repair, combined with tailored rehab, can yield excellent radiologic and functional outcome. Level of evidence: IV.