Abstract
IntroductionPosterior shoulder fracture-dislocation is a rare emergency condition with poor prognosis when there is a delay in diagnosis and presence of associated injuries.Case presentationWe present a case of a neglected four-part fracture-dislocation of the proximal humerus in a 34-year-old Greek woman. Except from the substantially displaced and comminuted tuberosity fractures, an anterolateral defect of approximately 50% of the articular surface was apparent. Open reduction of the humeral head was followed by reconstruction of the proximal humerus with allograft impaction, transfer of lesser tuberosity to the humeral defect and anatomic fixation of the greater tuberosity and humeral neck fractures. At two and a half years postoperatively, the humeral head was revascularised and properly articulated with the glenoid fossa.ConclusionThe presented case underlines the variability of injury pattern, the potential of missed diagnosis and the need for preserving the humeral head in young patients regardless of the amount of articular surface defect and disruption of soft tissue attachments.
Highlights
Posterior shoulder fracture-dislocation is a rare emergency condition with poor prognosis when there is a delay in diagnosis and presence of associated injuries.Case presentation: We present a case of a neglected four-part fracture-dislocation of the proximal humerus in a 34-year-old Greek woman
The presented case underlines the variability of injury pattern, the potential of missed diagnosis and the need for preserving the humeral head in young patients regardless of the amount of articular surface defect and disruption of soft tissue attachments
We present a case of a neglected four-part posterior fracture-dislocation of the proximal humerus in a young woman
Summary
Posterior shoulder fracture-dislocation continues to be a "diagnostic trap" for the unaware physician despite the advances in imaging techniques and the continuous flow of information about the risk of missed diagnosis. Open reduction of the humeral head, stable fixation of all of the associated fractures and filling of the anterolateral defect with graft and/or transfer of lesser tuberosity may lead to optimum result and good functional recovery. Posterior fracture-dislocations which were treated within 2 years of the injury had good shoulder function in comparison with neglected and misdiagnosed cases. The mild dislocation arthropathy was attributed to the loss of the concavitycompression effect and alteration of joint biomechanics after lesser tuberosity transfer in a non-anatomic position. Avascular necrosis of the humeral head is unpredictable and may occur in any posterior fracture-dislocation pattern, neglected injuries and fracture of the anatomic neck substantially increase the above incidence [13]. Accurate reduction and stable internal fixation – even if performed late – enhance the probability of successful revascularisation of the humeral head and avoid
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