Dr. Garcia demonstrates his technique for locked posterior dislocation (Modified Mclaughlin Procedure)

This video features Dr. Grant Garcia demonstrating a highly complex open procedure to treat a locked posterior shoulder dislocation using a modified McLaughlin procedure. The case is uniquely challenging because the patient also suffered a concomitant spiral fracture of the proximal humerus, which required a plate and screws for fixation prior to addressing the dislocation.

The chronic posterior dislocation resulted in an engaging reverse Hill-Sachs lesion—a bone defect on the front of the humeral head caused by the socket rim repeatedly crushing it during dislocation events.

The surgical strategy is executed through the following key steps:

• Surgical Exposure & Primary Fixation: Using a standard deltopectoral approach, Dr. Garcia first addresses the proximal humerus fracture by securing it with a locking plate. He then manually reduces the posterior shoulder dislocation and packs bone graft into the reverse Hill-Sachs crater to restore the humeral head's structural volume.
• Lesser Tuberosity Osteotomy: To access the joint and protect the critical subscapularis tendon from tearing, Dr. Garcia takes a small fleck of bone (osteotomy) off the lesser tuberosity. This bone fleck is left attached to the tendon, maintaining a solid tissue-to-bone interface.
• Biomechanical Anchor Selection: Rather than using traditional cortical bone screws, which risk stripping in soft, spongy cancellous bone, Dr. Garcia implements high-strength suture anchors. He drills and places two 6.25 mm SwiveLock anchors directly inside the defect zone, taking care to angle them away from the previously placed trauma plate.
• Subscapularis Transposition (Reverse Remplissage): All eight limbs of the heavy anchor sutures are passed directly through the subscapularis tendon and its bone fleck. The sutures are sequentially tied from top to bottom using alternating half-hitches, filling and "plugging" the defect with the tendon to mechanically prevent the shoulder from slipping backward again.
• Double-Row Crisscross Construct: To complete the repair, the remaining suture tails are split, tensioned, and crossed diagonally over the subscapularis tendon. They are locked down laterally into the bone using two 4.75 mm SwiveLock anchors. In a highly efficient maneuver, Dr. Garcia also performs a biceps tenodesis and integrates the biceps tendon tail directly into the topmost lateral anchor.

The final physical examination confirms an incredibly rigid repair. Even under maximum internal rotation, the humeral head remains perfectly centered in its socket without catching. Post-operatively, the patient is placed into a specialized "gunslinger" shoulder brace to protect the reconstructed subscapularis during early healing.