Anterior Fracture Dislocation Research Articles

Three-Part Fracture Dislocation and Four-Part Fracture Dislocation of the Proximal Humerus: How Different are the Glenoid Labrum and Capsular Injuries Between Them?

Anterior fracture dislocation of the shoulder may have associated injury to the glenoid labrum and/or capsule. There is a need to look at the possible patterns of capsulo-labral injuries intra-operatively and correlate them with pre-operative radiographs and CT scans. It can enable surgeons to predict the patterns of soft-tissue injuries in a specific fracture type. Patients operated for ORIF of 3- and 4-part anterior fracture dislocation between January 2017 and December 2022 were included in the study. The following data were collected: demographic details, fracture morphology and classification on radiograph and CT scan, neurovascular injury, the subtype of anterior dislocation, and intra-operative identifiable injury to glenoid labrum and/or capsule. A total of 24 cases (mean age 40 ± 10years) of anterior fracture dislocation of the shoulder were included in the study and were grouped based on Neer's classification. 12 patients had 3-part anterior fracture dislocation (3-part Group) with a mean age of 34 ± 9years, while 12 patients had 4-part anterior fracture dislocation (4-part Group) with a mean age of 46 ± 7years (p = 0.001). 10 out of 12 patients in the 3-part Group had the subcoracoid position of the dislocated head, whereas the head was present in 9 out of 12 patients of the 4-part Group at the preglenoid position (p = 0.003). The head position was at a mean distance of 1.85cm from the anterior glenoid rim in the 4-part Group, whereas the head was engaged at the anterior rim of the glenoid in the 3-part Group. The medial metaphyseal beak was present in 11 out of 12 patients in the 3-part Group, whereas it was absent in all the cases of the 4-part Group (p = 0.001). 92% of the included patients in our study had capsulo-labral injury. 11 out of 12 patients in the 3-part Group had labral injury compared to 10 out of 12 patients in the 4-part Group with severe capsular stripping (p = 0.001). The 3-part fracture dislocation with radiological findings such as the long medial metaphyseal beak and subcoracoid position of the dislocated head had a strong association with a glenoid labral injury, whereas the 4-part fracture dislocation type had a widely displaced preglenoid position of the dislocated head with an absent metaphyseal beak and had a strong association with a capsular type of soft-tissue injury. III.

Anterior fracture-dislocation of the glenoid

Fractures of the scapula represent less than 1% of all skeletal fractures. This case report describes an unusual case of fracture of the scapula with complete anterior dislocation of the glenoid and pillar of the scapula occurring in the right (dominant) shoulder of a 24-year-old male after a high-energy trauma (motorcycle accident). This fracture is very rare and did not fit in any known classifications (Ideberg, Euler and Rüedi, AO/OTA). The fracture was treated with open reduction and internal fixation through a double approach (deltopectoral and superior). A posterior cruciate ligament (PCL) guide was used to maintain the reduction and insert first a K-wire and then a cannulated screw. We discuss here the mechanism of injury, fracture pattern and the appropriate surgical approach and management in case of such an exceptional anterior fracture-dislocation of the glenoid.

A delayed presentation of bilateral anterior fracture dislocation of the shoulder from a domestic electric supply

Bilateral anterior fracture dislocation of the shoulder secondary to a high voltage electric shock is extremely rare, with only a few case reports available. To our knowledge, a prolonged delayed presentation (>4weeks) of an anterior fracture dislocation of the shoulder has not yet been reported in the English literature. We report an unusual case of a bilateral anterior fracture-dislocation of the shoulder, following an electric shock from a high voltage domestic electric supply. The patient was treated operatively with an open-reduction of both dislocated shoulder joints, followed by splinting immobilisation of the joint in full internal rotation for 3 weeks and attendance to physiotherapy for 6 months. At the last follow-up after more than 10 years after the injury, the patient was pain free with no impingement of activities of daily living and had returned to his former job.

A delayed presentation of bilateral anterior fracture dislocation of the shoulder from a domestic electric supply

Bilateral anterior fracture dislocation of the shoulder secondary to a high voltage electric shock is extremely rare, with only a few case reports available. To our knowledge, a prolonged delayed presentation (>4 weeks) of an anterior fracture dislocation of the shoulder has not yet been reported in the English literature. We report an unusual case of a bilateral anterior fracture-dislocation of the shoulder, following an electric shock from a high voltage domestic electric supply. The patient was treated operatively with an open-reduction of both dislocated shoulder joints, followed by splinting immobilisation of the joint in full internal rotation for 3 weeks and attendance to physiotherapy for 6 months. At the last follow-up after more than 10 years after the injury, the patient was pain free with no impingement of activities of daily living and had returned to his former job.

Traumatic Anterior L4 Fracture Dislocation With Iliac Artery Compression in a 6-Year-Old Patient: A Case Report.

A six-year-old Caucasian boy sustained an L4 anterior fracture dislocation with cauda equina transection at L3/L4 level with L4 vertebral body compression of the left common iliac artery after a single motor vehicle accident. He was treated with emergent open reduction and pedicle screw fixation with return of left common iliac patency. This was followed by multiple bowel resections on postadmission day 3. Anterior spinal fracture dislocations in pediatric patients are rare, caused by high-energy collisions, and are often complicated by multiple traumatic injuries, including vascular and neurological compromise that necessitate emergent intervention.

Anterior elbow fracture dislocation with ulnar nerve palsy in a six-year-old child

Background. Anterior elbow fracture dislocation is rare, especially in paediatric age group. Of the reported cases to date, three-quarter were posterior dislocation of the elbow. Anterior elbow dislocation is rarely reported, with incidence of only 2%.
 Clinical case. A 6-year-old girl presented to casualty with left elbow deformity and pain after she tripped and fell in the toilet. Ulnar clawing was present with reduced sensation over ulnar nerve distribution. No wound was found, distal pulses and circulation were good. The X-rays showed anterior dislocation of the left elbow with olecranon fracture. Closed manual reduction was attempted but failed. Open reduction and percutaneous K-wire insertion under general anaesthesia was performed. Medial approach of the elbow was done. Intra-operatively ulnar nerve was found impinged by the distal ulnar fragment but was in continuity. The transverse olecranon fracture was fixed with two K-wires and the radial head was reduced. Ulnar nerve was mobilised until tension-free. Ulnar collateral ligament was repaired. The elbow was immobilised with a splint. Ulnar claw was resolved at 2 weeks. The fracture heals and the K-wires were removed at 6 weeks. At 8 weeks, range of movement of the elbow was full. The elbow was stable in varus and valgus.
 Discussion. Anterior elbow dislocation is a high energy trauma and one should be cautious of neurovascular injury. There was no clear recommendation in the literature regarding surgical approach. We chose medial approach of the elbow for ulnar nerve exploration and olecranon fixation.
 Conclusion. This rare injury should be treated with high index of suspicious. Surgical approach should be tailored individually according to the instability of the elbow joint and neurovascular status, as in this case was the posteromedial instability associated with ulnar nerve palsy.

Anterior fracture dislocation of proximal humerus with anatomical neck fracture: Case report and review of literature

Anterior fracture dislocation of proximal humerus with anatomical neck fracture: Case report and review of literature

Bilateral symmetrical anterior fracture dislocation of shoulder

<p>The incidence of simultaneous bilateral shoulder joint dislocation is rare and is almost always posterior usually caused by violent muscle contraction as in patients with seizure disorders or who experience electric shock or undergo electroconvulsive therapy. simultaneous bilateral fracture-dislocation is even rarer, with a few cases reported in the literature. We report an unusual case with dislocation of the both shoulder joints in anterior direction after a seizure episode, With symmetrical unifocal 2-part extraarticular vertical fracture of proximal end segment of humerus (11A3) both sides. Although there have been a few reports of bilateral symmetrical fracture dislocations of the shoulder in the past, an injury pattern resembling our case has, to the best of our knowledge, not been described in the literature so far. Our report describes regarding the mechanism of injury in a case of a bilateral symmetrical anterior fracture dislocation following a seizure episode that treated with open reduction internal fixation using proximal humerus internal locking system (PHILOS). At final follow-up, the patient had healed fractures, painless near normal range of motion.</p>

Contralateral Fracture-Dislocation of the Shoulder Due to Electric Shock

Electrical injuries are relatively common and can produce various types of adverse effects on organs, but injuries to the musculoskeletal system are less frequent. Bone injuries can involve both long and flat bones and they encompass several types: osteonecrosis, dislocation, and fracture. Cases of shoulder dislocation with fracture have been reported in the literature; the mechanism is linked to the tetanizing effect from the alternating current flow through the shoulder without a fall or a violent trauma. Posterior dislocation is the most common shoulder injury. We report the case of an anterior fracture-dislocation of the shoulder contralateral to the entry point and we emphasize that any pain or functional impotence in the context of electric shock, even when it’s distant from the entry point, should trigger suspicion of bone injury.

Anterior Shoulder Fracture Dislocations in A Patient With Stiffmans Syndrome and Convulsive Disorder: Rare Case Report

Anterior shoulder fracture dislocation is a challenging case though commonly seen in conjunction with convulsive disorders. No case of stiff-Person Syndrome (SPS) presenting with anterior fracture dislocation is reported in the literature. SPS is estimated to have a prevalence of about one per million with the first known description being attributed to Moersch and Woltman in 1956. The diagnosis and injury patterns of anterior fracture dislocation are more clearly seen on Computed Tomography (CT) Scans which also aids in planning for the surgical management. The treatment outcome after surgical reduction and internal fixation of the fracture with dislocation is associated with excellent functional results.

Modified less invasive anterior subcutaneous fixator for unstable Tile-C-pelvic ring fractures: a biomechanical study

BackgroundOperative procedures for unstable pelvic ring fractures remain controversially discussed. Minimally invasive treatment options for pelvic ring fractures have several benefits for the patient. But they can also provide disadvantages. Anterior subcutaneous pelvic fixation (INFIX) has shown promising biomechanical results in pelvic ring fractures, but there is a high complication rate of nerve injuries. An additional screw to the INFIX seems to be more stable. The aim of this study is to compare biomechanical stability of a new modified unilateral INFIX fixing the unilateral injured pelvic ring with the standard INFIX.Methods24 composite synthetic full pelvises were used in this study. 4 groups each with a number of six pelvic specimens were randomly assigned. A C1.3-type pelvic fracture was made with an osteotomy of the sacrum and an osteotomy of the anterior pelvic ring. Fracture fixation was performed within the four groups: (1) unilateral INFIX, (2) “extended” unilateral INFIX + additional pubic ramus pedicle screw, (3) bilateral INFIX, (4) “extended” bilateral INFIX + additional pubic ramus pedicle screw. All specimens were cyclic loaded with 200 N until maximum of 300 N. Distance/dislocation of the fracture fragments were detected with 3D-ultrasound measuring system. Stiffness was calculated.ResultsExtended unilateral INFIX showed the lowest mean dislocation. Lowest rotational stability was displayed by the standard bilateral INFIX. A significant difference (P = 0.04) was shown between the extended unilateral INFIX and the “standard” bilateral INFIX in terms of rotational stability. Extended unilateral INFIX showed significantly improved stability of anterior fracture dislocation (P = 0.01) and unilateral INFIX showed the highest rotational stiffness. Anterior fixation stiffness of the unilateral INFIX was significantly improved using an additional symphysis/pubic ramus screw (P = 0.002).ConclusionExtended unilateral INFIX (+ additional pubic ramus pedicle screw) is a feasible minimally invasive treatment for anterior pelvic ring fractures. Higher stability and lower probability of bilateral nerve damage is provided by the extended unilateral INFIX compared to the standard bilateral INFIX.

Anterior fracture dislocation of the proximal humerus

Anterior fracture dislocations are among the most severe forms of proximal humeral fractures. Because of potential devascularization of the humeral head, it is unclear whether open reduction and internal fixation (ORIF) offers superior results to primary hemiarthroplasty (HAS) or reverse shoulder arthroplasty (RSA). We retrospectively compared functional outcomes, complications, and revision surgeries after ORIF, HSA, and RSA in 81 patients with anterior fracture dislocations. Functional results were assessed with the age- and gender-normalized Constant Score (nCS). Of 81 anterior fracture dislocations, 40 (49.4%) were treated by ORIF (mean age 61.5 ± 13.9 years, range 29–89), 19 (12.3%) by HSA (mean age 71.6 ± 10.1 years, range 53–85), and 22 (27.2%) by RSA (mean age 79.8 ± 10.8 years, range 58–91). Of 81 patients (75.8% women, mean age: 67.4 ± 12.5 years, range 29–91 years), the mean nCS after 3.4 ± 2.9 years of follow-up was 63.4 ± 10.3 after ORIF, 52.4 ± 12.9 after HSA, and 74.5 ± 11.1 after RSA (ANOVA, p = 0.001). The complication rate in ORIF procedures was 22.5% (secondary displacement n = 2, avascular necrosis n = 7), in HSA, 36.8% (tubercle dislocation n = 4, tubercle resorption n = 2, septic loosening n = 1), and RSA, 13.6% (acromial fracture n = 1, tubercle displacement n = 1, tubercle resorption, n = 1; p < 0.001). Avascular necrosis was observed in 17.5% of cases following a primary head-preserving treatment. Treatment of anterior fracture dislocations is demanding. Open anatomic reduction and internal fixation can lead to good and excellent functional outcomes in young patients with good bone quality and should be performed in these patients as soon as possible. Elderly and frail patients may profit from RSA as a primary treatment. HSA should be reserved for cases where anatomic reduction and stable fixation in patients <65 years has failed; however, functional outcomes are poor.

Accidental electric shock injuries around the shoulder joint: A case report of two patients

Fracture-dislocations of the shoulder are grave injuries. These injuries rarely are caused by electrocution injuries. The diagnosis of these injuries is tricky. Missed diagnosis of these injuries is common due to inadequate radiological examination. We report two cases of fracture-dislocation of the shoulder following accidental electrocution injuries. Our case report includes two patients who injured their shoulder joints after suffering accidental electric shock injuries. Our first patient was an 80-year-old female who suffered an anterior fracture-dislocation of the shoulder and second patient was a 28-year-old male who suffered a posterior fracture-dislocation. Both the patients were treated by osteosynthesis using the deltopectoral approach. Our patients had a good function of their shoulders at the end of 1-year follow-up. Fracture-dislocations of the shoulder pose a significant diagnostic threat and are often missed due to inadequate radiographs. These injuries can be successfully treated by early diagnosis and anatomical fixation of the fracture. Avascular necrosis of the head of the humerus is the significant complication to these injuries.

When is it safe to reduce fracture dislocation of shoulder under sedation? Proposed treatment algorithm.

Shoulder dislocations are common. It is known that incongruent shoulder should be promptly reduced. However, when associated with fracture of the proximal humerus, there is a clinical dilemma if reduction under sedation is a safe option. We wanted to establish when it is safe to attempt reduction of a shoulder fracture dislocation under sedation in emergency room. This is a retrospective cohort study assessing consecutive patients presenting with a dislocation of a gleno-humeral joint with an associated fracture of the humerus between 2007 and 2015. The radiographs and patients' records were examined. The number of fragments according to Neer's criteria and size of fragments were recorded. We identified 102 patients who presented with 104 cases of fracture dislocation of shoulder joint. 10 of the dislocations were posterior, remainder were anterior. All posterior dislocations were reduced under general anaesthesia. Sixty-two anterior fracture dislocations had attempted reduction under sedation in emergency department. Eight of those were unsuccessful, and patient required general anaesthetic for further management. In five of those cases, significant displacement of humeral head in relation to the shaft after attempted reduction. We propose pragmatic approach to the initial treatment of fracture dislocations of shoulder. In type I injury, where there is an anterior dislocation with greater tuberosity fracture, one should attempt a reduction under sedation; 94% of attempted reductions under sedation were successful and no fracture propagation occurred. In case of a type II injury, when the fracture is involving a surgical neck of the humerus with or without greater tuberosities fracture, our experience suggests that no attempt of reduction is undertaken under sedation and patient has general anaesthetic. Posterior dislocation with any fracture remains an unsolved problem, but in our series no attempt of reduction under sedation was made.

Ulnar Claw-Hand Related Neglected Post-Traumatic Anterior Shoulder Joint Dislocation

Shoulder joint is the most frequently dislocated joint. Humeral head dislocation pushed the nerve toward medial side. Neglected shoulder dislocation is difficult to manage and requires extensive procedures to obtain good functional outcome. In the case of negligence, it is often found loss of the anterior capsule due to absorption of the capsule. Nerve lesions, in particular the ulnar nerve, often do not receive attention. Clinically, it often occurred from neurapraxia to severe condition like claw-hand deformity. In my experience of a neglected case, there was a 53-year-old woman who presented to the orthopaedic clinic with a left anterior shoulder fracture dislocation following a fall onto the right shoulder and upper right arm. She had treated herself at home for around six months before visiting the clinic. She also complained of some deformities on her ring and little fingers, known as ulnar claw-hand. Numbness and tingling on her left hand especially on the ring and little fingers were observed. These findings were carefully documented and the patient was aware of these persistent abnormalities. She had electromyography (EMG) and nerve conduction velosity (NCV) examination evidence of persistent ulnar nerve deficit, performed before and after surgery. We may conclude that this case highlights the need for awareness of the potential for nerve damage following shoulder dislocation. After treating the dislocation, the functional and EMG results are very satisfactory.

Efficacy analysis of a novel sternoclavicular hook plate for treatment of unstable sternoclavicular joint dislocation or fracture.

Sternoclavicular joint is an amphiarthrodial joint formed by the clavicle and sternal manubrium. This joint becomes chronically unstable in case of a medial clavicle dislocation or fracture, and improper treatment could cause malformation and pain. We aimed to determine the efficacy of a novel sternoclavicular hook plate for treatment of unstable sternoclavicular joint dislocation or fracture. Between June 2011 and December 2013, the sternoclavicular hook plate was used to surgically treat 32 adult patients with unstable sternoclavicular joint dislocation or fracture. Of these, 12 and 5 patients suffered from anterior and posterior dislocation of the sternoclavicular joint, respectively, 10 had medial clavicle fracture, and 5 had fracture dislocation. For anterior fracture dislocation, the standard sternoclavicular hook plate was used, while for the posterior dislocation, screws were added at the distal end of the hook plate, anterior to the sternal manubrium, to prevent postoperative redislocation. No intraoperative complications were observed during the procedure. Postoperative X-ray and computed tomography revealed normal anatomical positions of sternoclavicular joints and excellent positions of internal fixation. About 3-6 months after surgery, all patients achieved primary healing without redislocation of the sternoclavicular joint along with satisfactory restoration of anatomical structures of the medial clavicle; nine patients had swelling but no pain around the sternoclavicular joints. Internal fixation was removed in 29 patients 6-12 months postoperatively and no sequelae were observed. This novel sternoclavicular hook plate demonstrated excellent efficacy and could provide a reliable therapeutic approach for this kind of trauma.

Combined three-part humeral anterior fracture-dislocation and humeral shaft fracture treated with one-stage long stem shoulder hemiarthroplasty in an active elderly patient - A case report and review of literature.

Introduction: Injuries combining a humeral head fracture-dislocation and a shaft fracture of the ipsilateral humerus are very rare. They should be separated from extended fractures of the humeral head to the shaft [1]. Case report: We present the case of an active 84-year-old man who sustained a three-part fracture-dislocation of the proximal humerus combined with a long spiral humeral middle third diaphyseal fracture, after a ski fall. We were unable to find a similar case in the literature. He was treated with a long stem hemiarthroplasty, associated with screw osteosynthesis of the long spiral shaft fracture. The result after 30 months of follow-up was excellent, with good shoulder range of motion, good bone integration of the prosthesis and uneventful healing of the fracture. Conclusion: This treatment allowed this intrepid elderly patient to recover a normal quality of life, including driving his car and to return to skiing.

Reduction of anterior glenohumeral dislocations: a new closed reduction technique

ABSTRACTObjective: A new closed reduction technique for anterior glenohumeral dislocations and tuberosity fracture dislocations is introduced.Methods: Forty-one consecutive patients with an acute anterior glenohumeral dislocation or tuberosity fracture dislocation underwent closed reduction by an orthopaedic surgeon employing this new method.Results: Closed reduction was successful in 88% of patients using the reduction maneuver. Associated fracture with glenohumeral dislocation did not influence the success rate of the reduction maneuver. An assistant was needed in 15% of cases. No complications related to the reduction maneuver were noted amongst the cohort.Conclusion: This novel reduction technique is safe demonstrating excellent success rates both for anterior shoulder dislocations and tuberosity fracture-dislocations.

A new type sternoclavicular hook plate for unstable sternoclavicular joint dislocation and fracture

To evaluate the therapeutic effect of a new type sternoclavicular hook plate fixation in treating unstable sternoclavicular joint dislocation and fracture. From June 2011 to December 2013, 32 patients with sternoclavicular joint dislocation and fracture were treated with a new type sternoclavicular hook plate fixation, including 24 males and 8 females with an average age of 42 years ranging from 25 to 76 years;12 patients were anterior dislocation, 5 pations were posterior dislocation, 10 patients were internal extremity of clavicle fracture and 5 patients were sternoclavicular joint dislocation combined with fracture. The anterior fracture dislocation of the sternoclavicular joint adopted standard sternoclavicular joint hook plate, and the posterior dislocation was at the distal end of the hook of the steel plate, that is, the front part of the handle of the breast was added with a nut and a gasket to prevent the re-dislocation after operation. The results were evaluated according to Rockwood score. No complication happened in all patients. X-ray and CT showed that the dislocation and fracture of the sternoclavicular joint was well reduced and the plate was on right position. All patients were followed up for 6 to 24 months with an average of 10 months. At 6 to 3 months after operation, the fracture was healing without re-dislocation of the sternoclavicular joint, the medial end of the clavicle anatomical structure were restored, functional satisfaction, in which 9 patients with the swelling around sternoclavicular joint, but no pain and other symptoms. The total Rockwood score was 12.78±1.43; the results were excellent in 24 cases, good in 8 cases. The use of the new type of locking hook plate for the treatment of unstable fracture of the sternoclavicular joint, internal fixation is reliable, high security, easy to operate, to provide a reliable method for the treatment of such trauma.

Fracture line distribution of olecranon fractures.

The association between specific olecranon fracture characteristics (e.g., displacement, fragmentation, subluxation) and fracture line distribution might help surgeons predict intra-articular fracture location based on fracture characteristics that can be determined on radiographs. We hypothesized that fracture mapping techniques would reveal different fracture patterns for minimally displaced fractures, displaced fractures, and fracture-dislocations of the olecranon. A consecutive series of 78 patients with olecranon fractures were evaluated using initial radiographs and computed tomography scans and characterized according to the Mayo classification. Fracture lines were identified based on reduced three-dimensional computed tomography reconstructions and graphically superimposed onto a standard template to create two-dimensional fracture maps. The fracture maps were then converted into fracture heat maps. Based on fracture and heat maps, fracture line location and patterns were determined. Six (7.7%) patients had a non- or minimally displaced fracture, 22 (28%) a displaced fracture, and 50 (64%) a fracture-dislocation of the olecranon. There were 27 (54%) anterior and 23 (46%) posterior olecranon fracture-dislocations. Fracture lines of non- or minimally displaced fractures and posterior fracture-dislocations enter and exit the trochlear notch at the base of the coronoid, while fracture lines of displaced fractures and anterior fracture-dislocations were spread more broadly over the depths of the trochlear notch. Based on fracture characteristics depicted on radiographs, one can anticipate the amount of the olecranon involved (how close is the fracture line to the coronoid) and the orientation of the fracture line. Computer tomography could be reserved for when more specific knowledge of the fracture line might affect treatment. III.