ORIGINAL ARTICLE Posterior capsular release and coracoid transfer for cases of neglected locked anterior shoulder dislocation in tramadol addicts Amr M. Abdelhady & Maged M. AbouElsoud Received: 4 August 2014 /Accepted: 8 September 2014 /Published online: 14 September 2014 # EFORT 2014 Abstract Introduction Neglected locked anterior shoulder dislocation is a rare condition as the injury is easily detectable. The humeral head is engaged against the anterior glenoid rim with a large Hill-Sachs defect. Due to the time lapse, there is additional soft tissue tightness. Our hypothesis is that Latarjet procedure combined with posterior capsular release will pro- vide a stable shoulder with less limitation of external rotation in such cases. Patients and methods This prospective study was conducted on six shoulders. They were all addicted to tramadol and experienced fits which led to the dislocations. The mean age was 26.5 years. The mean presentation time was 9.16 weeks after injury. They all had locked anterior shoulder dislocation with mean Hill-Sachs lesion of 34 % of humeral head size. Open reduction through deltopectoral approach was done. The coracoid was osteotomized at the junction of the transverse and ver- tical part. The posterior capsule was released just after “unlocking” of the dislocation. After reduction, the cor- acoid was fixed to the freshened glenoid neck to in- crease the glenoid arc and avoid engaging of the hu- meral head defect. The subscapularis was re-attached in neutral rotation position. Results The mean follow up was 36.66 months. None of the cases had dislocation. The mean postoperative Constant score was 78.6, the postoperative Rowe score was 73.3, and external rotation in adduction was 46°. Discussion The results obtained support our hypothesis that, Latarjet procedure provides a stable and functional glenohumeral joint in cases of neglected anterior shoulder dislocation. Keywords Addiction . Hill-Sachs defect . Latarjet procedure . Shoulder dislocation . Tramadol Introduction Locked anterior shoulder dislocation is a rare problem to face in orthopedic practice. Moreover, being missed, and subse- quently encountered as neglected, is very rare as it is easily diagnosed [1]. Tramadol addicts tend to experience recurrent convulsive fits and subsequent shoulder violent dislocations [2, 3]. Patients usually are reluctant to seek specialized med- ical consultation. Some of them are presented with the prob- lem of neglected locked anterior shoulder dislocation. The pathology is always a large bony “Hill-Sachs” defect together with soft tissue tightness due to the time lapse. Release of the tight posterior capsule and management of the head defect to avoid its further engagement against the glenoid rim is needed to avoid future recurrence [4]. We believe that with growing addiction to tramadol, this condition will be more frequently encountered. The use of bone allograft to reconstruct the head defect has been described as a management option with good outcome, but this option is not available in all counties [5]. Infraspinatus tenodesis (remplissage) provides a stable shoul- der but with limitation of external rotation [ 4 , 6 ]. Transhumeral headplasty has also been described but is diffi- cult in neglected and large, Hill-Sachs defects; disimpaction may be most suited to acute lesions of less than 3 weeks old [7]. As these patients are usually young, shoulder arthroplasty is a remote surgical option. The high possibility for recurring fits makes relying solely on soft tissue procedures to stabilize the shoulder may be unreliable and subjected to failure [8]. Moreover, we need not only a stable joint, but a good function regarding range of motion and power. It is our hypothesis that an open reduction together with the release of the tight poste- rior capsule followed by a Latarjet procedure [9] to render the A. M. Abdelhady (*) : M. M. AbouElsoud Ain Shams University, Cairo, Egypt e-mail: dramr_sharaf@med.asu.edu.eg Eur Orthop Traumatol (2015) 6:39–43 DOI 10.1007/s12570-014-0279-6