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Hill-Sachs Lesions

The most common bony lesion associated with traumatic glenohumeral instability is a compression fracture at the posterolateral margin of the humeral head Commonly known as a Hill-Sachs lesion, this fracture occurs as the humeral head impacts the glenoid edge during dislocation.

The lesion is present in 80% of anterior dislocations, 25% of anterior subluxations, and almost 100% of cases of recurrent anterior instability. With posterior instability, a reverse Hill-Sachs lesion results from impaction of the articular surface when the humeral head dislocates over the posterior glenoid rim.

These articular humeral lesions rarely contribute to instability, as they are usually small; however, when the lesion includes more than 30% of the articular surface and associated with instability, it may be an important indication for surgery. Such large lesions occur only after recurrent dislocations. Gerber and Lambert have demonstrated that one option of treating these kinds of injuries is restoration of normal articular cartilage conformity by allograft reconstruction.

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