Progressive Soft Tissue Release and Latarjet Procedure in the Treatment of Neglected Anterior Shoulder Dislocation After Failed ORIF in a Young Active Patient: A Case Report.

Abstract

Background: Neglected anterior shoulder dislocation (NASD) is rare, representing less than 2% of all shoulder dislocations, and poses a complex surgical challenge driven by chronic soft tissue contracture, bone loss, and risk of humeral head collapse. Most evidence derives from case series in elderly patients, and reports detailing progressive soft tissue release strategies in young active individuals remain scarce.

Case presentation: A 25-year-old male kitesurfer presented with an 8-month history of NASD following unsuccessful open reduction and internal fixation for a proximal humeral fracture-dislocation. The patient had marked limitation in range of motion and visible deformity, without axillary nerve dysfunction, with imaging findings of 30% glenoid bone loss. Surgical management consisted of progressive soft tissue release and controlled open reduction, including coracoid osteotomy, upper two-thirds subscapularis tenotomy, supraspinatus release, and posterior capsulotomy, followed by a conventional Latarjet procedure. At 24-month follow-up, the patient demonstrated significant improvement in range of motion, patient-reported outcomes (Constant 92, ASES 95), complete pain relief, maintained joint stability, and partial return to recreational kitesurfing, without complications.

Conclusions: A structured approach based on progressive soft tissue release combined with stepwise open reduction is essential to safely restore joint congruency in NASD. In selected young patients with significant glenoid bone loss, the Latarjet procedure provides stability and supports favorable functional outcomes.