Intrathoracic Fracture–Dislocation of the Proximal Humerus Treated With Reverse Total Shoulder Arthroplasty

Abstract

High-energy trauma to the shoulder can lead to complex fractures and dislocations that challenge even the most experienced orthopedic surgeon's reconstructive capabilities. One such injury is a fracture-dislocation of the proximal humerus, in which the humeral head becomes impaled in the thoracic cavity. This article presents a case of a 67-year-old woman who sustained an intrathoracic fracture-dislocation of the proximal humerus after a fall down a flight of stairs. After emergent extrication of the intrathoracic humeral head and proximal medial shaft, the patient underwent delayed shoulder reconstruction with a reverse total shoulder arthroplasty and allograft augmentation. The reverse shoulder was used due to the high-energy comminution, stripping of the remaining tuberosity fragments, and extensive proximal bone loss. The patient's functional ability would therefore depend on the biomechanical design of the prosthesis and not solid healing of the severely compromised tuberosity pieces. The proximal shaft was reconstructed using a femoral strut allograft that was cabled into place. This was done to restore the medial humeral calcar that was missing due to her injury. The shoulder was then reconstructed using the Reverse Shoulder Prosthesis (Encore Medical, Austin, Texas). This is the first description of the reverse total shoulder used for intrathoracic fracture-dislocation of the proximal humerus. The reverse total shoulder arthroplasty is a viable option to treat complicated proximal humerus trauma in the appropriately selected patient.