Hill-Sachs lesion
| Classification according to ICD-10 | |
|---|---|
| S42.2 | Fracture of the proximal end of the humerus |
| S43.0 | Dislocation of the shoulder joint |
| ICD-10 online (WHO version 2019) | |
A Hill-Sachs lesion (also known as Hill-Sachs dent) is an impression in the head of the humerus through the shoulder socket , which can affect the cartilage or the bones and cartilage. This injury is the result of frequently repeated shoulder dislocations (shoulder dislocations). Depending on the direction of the dislocation, there is a posterior, i.e. dorsal (anterior dislocation) or anterior - ventral - (posterior dislocation) Hill-Sachs defect. The eponym honors Harold Arthur Hill and Maurice David Sachs .
Emergence
The defect arises from pressure of the edge of the socket on the head of the humerus in the course of a shoulder dislocation. The defect lies dorso-laterally on the humeral head with an anterior shoulder dislocation. With a posterior shoulder dislocation, the Hill-Sachs lesion lies ventro-cranially. One then speaks of an inverse Hill-Sachs lesion. A Bankart lesion usually occurs at the same time, i.e. a shearing of the rim of the socket ( limbus ) - anterior or posterior depending on the direction of dislocation - which can also only affect the cartilaginous edge or cartilage and bones.
therapy
The therapy to be performed depends on the type of injury. In the case of an anterior, lower, traumatic first dislocation, a Bankart lesion must first be searched for, even if the X-ray is normal. This is usually done using MRI or diagnostic arthroscopy. During the first operation, the Hill-Sachs defect, if any, is usually small and does not require targeted therapy. A simple arthroscopic or open surgical Bankart repair is sufficient .
In the case of recurrent or habitual dislocation with instability, further procedures are used: J-Span plastic according to Resch , surgery according to Eden-Hybinette , subcapital derotation osteotomy according to Weber . In the latter, the Hill-Sachs lesion is moved out of the load area of the shoulder and the derotation simultaneously tightens the posterior capsule, which prevents a renewed dislocation forwards.
In the much rarer but more complicated posterior dislocation, the impressed defect usually has to be removed ( lifted ) surgically , this is done by creating a drill hole in the rear area of the humerus head, via which the impression is pressed outwards with a pestle and by introducing cancellous bone ( Spongiosaplasty ) is stabilized. In more difficult cases, this elevation of the Imprimat must be combined with a posterior Bankart repair ( operation according to Scott and Kretzler ); in the case of very deeply impressed anterior Hill-Sachs defects, the small humerus ( minus tuberosity ) is moved into the defect ( operation according to Neer ) in question.
literature
- H. Resch, E. Beck: shoulder dislocation - shoulder instability. In: B. Breitner: Surgical operation theory. Volume X: Traumatology 3: Shoulder and Upper Limb. 2nd Edition. Urban & Schwarzenberg publishing house, Munich / Vienna / Baltimore 1991, ISBN 3-541-14502-1 .
- A. Widjaja et al .: Correlation between Bankart and Hill-Sachs lesions in anterior shoulder dislocation. In: ANZ J Surg. 76/2006, pp. 436-438. PMID 16768763 .
Web links
- Guideline shoulder dislocation, recurrent and habitual of the German Society for Orthopedics and Orthopedic Surgery and the Professional Association of Doctors for Orthopedics. In: AWMF online (as of 09/01/2009)
