English

Abstract

BACKGROUND: Posterior shoulder dislocations and fracture-dislocations are uncommon injuries that most often occur during seizures or as a result of high-energy trauma. Despite advances in imaging, they are frequently diagnosed late. Detection is facilitated by heightened clinical suspicion of the injury in high-risk individuals together with appropriate radiographic investigation. A wide variety of operative techniques, ranging from simple closed reduction to soft-tissue and bone stabilization procedures to prosthetic arthroplasty, are available to treat these injuries. Selection of the most appropriate treatment option is complex and multifactorial. Good functional outcomes are associated with early detection and treatment of isolated posterior dislocations that are associated with a small osseous defect and are stable following closed reduction. Poor prognostic factors include late diagnosis, a large anterior defect in the humeral head, four part fracture or arthrosis of the humeral head. CASE DESCRIPTION: A 24 year old male worker presented with persisting pain and stiffness in his right shoulder following high energy trauma 8 months back. Physical examination and radiological evidence showed posterior dislocation with humeral head fracture. Patient was treated by open reduction and reconstruction of the proximal humerus. Post operative follow up for 18 months showed good range of movements. Early diagnosis and treatment of this rare type can prevent deformities. INTRODUCTION: Posterior locked shoulder dislocation is an uncommon injury (2–4% of all shoulder dislocations) which may be misdiagnosed and overlooked in up to 60% of cases.1 The spectrum of associated injuries varies from the isolated impaction fracture of the anteromedial aspect of the humeral head (reverse Hill-Sachs lesion) to more complex fracture types of the proximal humerus (less than 1%) and shoulder girdle 1, 2. The unrecognized dislocation-fracture pattern can jeopardize the joint mobility and the vascularity of the humeral head predisposing to chronic instability, osteonecrosis and osteoarthritis .1 The management of posterior fracture dislocation after delayed diagnosis is complicated.3 CASE PRESENTATION: A 24-year-old right-hand dominant male worker, presented at the Vydehi Hospital complaining of persisting pain and stiffness in his right shoulder. The symptoms began 8 months earlier following a high energy trauma. The patient reported that he had taken native treatment with an osteopath where serial massages were done to relieve the pain, as there was no improvement in pain and shoulder mobility; he finally was referred to our hospital for a second opinion and further evaluation.