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Lahrach EM, Skalli H, Benameur H, Al Idrissi N, Jaafar A. A Locked Posterior Shoulder Dislocation: An Injury Not to Miss. Cureus 2024; 16:e66504. [PMID: 39246929 PMCID: PMC11380801 DOI: 10.7759/cureus.66504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2024] [Indexed: 09/10/2024] Open
Abstract
Locked posterior shoulder dislocations are dislocations that remain unreduced for more than three weeks. In most cases, they are associated with other injuries. We report the case of a 38-year-old male who presented with pain and total functional impotence due to a complex injury, including posterior glenohumeral dislocation, a reverse Hill-Sachs lesion, and a clavicle fracture. Because of the unsuccessful attempts at closed reduction, the patient underwent surgery. We performed the McLaughlin technique, which included the transfer of the subscapularis tendon to the reverse Hill-Sachs lesion, stabilized by bone anchors. At the last follow-up, the patient was doing well and had regained full range of motion with no recurrent dislocation. Clinicians should maintain clinical and radiological suspicion about this injury to timely manage this rare and dangerous injury.
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Affiliation(s)
- El Mehdi Lahrach
- Orthopaedics and Traumatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
- Orthopaedics and Traumatology, Avicenna Military Hospital, Marrakesh, MAR
| | - Hamza Skalli
- Orthopaedics and Traumatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Hamza Benameur
- Orthopaedics and Traumatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
| | - Najib Al Idrissi
- Orthopaedics and Traumatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
- School of Medicine, Laboratory of Genomics, Epigenetics, Personalized and Predictive Medicine, Casablanca, MAR
| | - Abdeloihab Jaafar
- Orthopaedics and Traumatology, Cheikh Khalifa International University Hospital, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR
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Koide M, Tateda S, Miyasaka S, Yasuyama A, Sasaki Y, Abe M. A Case of Neglected Posterior Fracture Dislocation of the Shoulder Treated With Greater Tuberosity Osteotomy. Case Rep Orthop 2024; 2024:6486750. [PMID: 38962284 PMCID: PMC11221983 DOI: 10.1155/2024/6486750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 05/07/2024] [Accepted: 05/29/2024] [Indexed: 07/05/2024] Open
Abstract
Posterior dislocation of the shoulder joint is a rare condition. It is often misdiagnosed owing to a lack of evident clinical features compared with anterior shoulder dislocation, and inappropriate radiological examination. We present a case of chronic posterior fracture dislocation treated with greater tuberosity osteotomy. A 66-year-old man was injured in a fall while carrying a drone. He was referred to our hospital following 3 months of conservative treatment at a nearby clinic, without reduction of the posterior dislocation. Physical examination revealed a prominent reduction in shoulder joint range of motion and shoulder pain. Radiological examination revealed posterior shoulder dislocation associated with greater tuberosity malunion and a small bone fracture of the posterior portion of the glenoid. Open reduction and internal fixation, including greater tuberosity osteotomy, were performed. Although subluxation of the posterior dislocation persisted postoperatively, the humeral head gradually returned to its centric shoulder joint position owing to rotator cuff force coupling. At 24-month follow-up, the patient showed excellent shoulder results.
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Affiliation(s)
- Masashi Koide
- Department of Orthopedic SurgeryJapanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Satoshi Tateda
- Department of Orthopedic SurgeryJapanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Sayaka Miyasaka
- Department of Orthopedic SurgeryJapanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Akihiro Yasuyama
- Department of Orthopedic SurgeryJapanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Yoichi Sasaki
- Department of Orthopedic SurgeryJapanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Mika Abe
- Department of Orthopedic SurgeryJapanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
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Paksoy A, Akgün D, Lappen S, Moroder P. Diagnosis and treatment of posterior shoulder instability based on the ABC classification. EFORT Open Rev 2024; 9:403-412. [PMID: 38726995 PMCID: PMC11099582 DOI: 10.1530/eor-24-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Posterior shoulder instability (PSI) is less common than anterior shoulder instability, accounting for 2-12% of total shoulder instability cases. However, a much higher frequency of PSI has been recently indicated, suggesting that PSI accounts for up to 24% of all young and active patients who are surgically treated for shoulder instability. This differentiation might be explained due to the frequent misinterpretation of vague symptoms, as PSI does not necessarily present as a recurrent posterior instability event, but often also as mere shoulder pain during exertion, limited range of motion, or even as yet asymptomatic concomitant finding. In order to optimize current treatment, it is crucial to identify the various clinical presentations and often unspecific symptoms of PSI, ascertain the causal instability mechanism, and accurately diagnose the subgroup of PSI. This review should guide the reader to correctly identify PSI, providing diagnostic criteria and treatment strategies.
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Affiliation(s)
- Alp Paksoy
- Charité University Hospital, Center for Musculoskeletal Surgery, Augustenburger Platz 1, Berlin, Germany
| | - Doruk Akgün
- Charité University Hospital, Center for Musculoskeletal Surgery, Augustenburger Platz 1, Berlin, Germany
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Muacevic A, Adler JR, Abdeljaouad N, Yacoubi H. Irreducible Posterior Fracture Dislocation of the Shoulder: A Case Report. Cureus 2023; 15:e33819. [PMID: 36819390 PMCID: PMC9930172 DOI: 10.7759/cureus.33819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2023] [Indexed: 01/19/2023] Open
Abstract
Posterior shoulder fracture-dislocation is a rare traumatic entity. Early diagnosis results in the adequate treatment of these lesions and prevents serious complications, such as avascular necrosis. Several therapeutic options have been proposed depending on the size of the humeral defect, duration of the dislocation, age of the patient, associated comorbidities, and functional requirements. For this kind of injury, early open anatomical reduction and stable internal fixation remain the optimum treatment option. Arthroplasty is often the last resort for active young patients, particularly in cases of avascular necrosis, humeral head complex fracture, or undiagnosed posterior shoulder dislocation. Here, we report a case of a complex posterior shoulder fracture-dislocation in a young man, which was treated surgically with open reduction and locked plate osteosynthesis using a deltopectoral approach.
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Long-term follow-up of a posterior glenohumeral fracture-dislocation treated with open reduction and internal fixation: a case report. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Egiazaryan KA, Ershov DS, Badriev DA, Soshnikov DY. Chronic non-treated posterior fracture-dislocation of the shoulder. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2022. [DOI: 10.24075/brsmu.2022.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Posterior fracture-dislocations often remain undiagnosed at initial medical attendance. In dislocation, the head of the humerus extends beyond the glenoid to form a zone of impaction, which “fixes” it. The injury is almost unidentifiable in standard frontal X-ray images. Meanwhile, continued fixation of the humerus in the state of posterior dislocation leads to a rapid progression of the traumatic impaction over up to 50% of the articular surface area. The associated damage to the articular lip of the scapula, rupture of the rotator cuff muscles, symptoms of shoulder instability after relocation, and severe pain syndrome require advanced treatments for this type of injury. Here we report a clinical case of anatomical neck fracture of the humerus with displaced consolidation, combined to posterior dislocation. To avoid subacromial impingement, instead of correcting the position of the head, we abandoned the reposition and performed an osteotomy with distal displacement of the greater tubercle of the humerus.
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Affiliation(s)
- KA Egiazaryan
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - DS Ershov
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - DA Badriev
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - DY Soshnikov
- Pirogov Russian National Research Medical University, Moscow, Russia
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Shermetaro J, Valk J, Sosnoski D, Brossy K. An Irreducible Posterior Fracture-Dislocation of the Shoulder: A Case Report. Cureus 2022; 14:e24535. [PMID: 35651412 PMCID: PMC9142166 DOI: 10.7759/cureus.24535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/05/2022] Open
Abstract
Posterior fracture-dislocations of the shoulder are exceedingly rare orthopedic injuries. The management of these rare and complex injuries can be challenging from initial presentation through definitive management. Timely diagnosis of these injuries is critical to prevent devastating complications, yet the diagnosis is often delayed. Delays in surgery and poor fracture reduction are associated with a high risk of complications such as avascular necrosis. Additionally, these injuries have the potential to be irreducible. This may occur secondary to osteochondral humeral defects, soft tissue interposition, or entrapment. The long head of the biceps tendon incarceration is one potential block to reduction. Definitive surgical treatment options include open reduction and internal fixation (ORIF) and shoulder arthroplasty. While reoperation rates are higher in patients undergoing ORIF, arthroplasty longevity is a concern among young, active patients with high functional demands. Fibular strut allograft is a useful adjunct when reconstructing complex proximal humerus fractures. We present a case of a 28-year-old male who sustained a significantly comminuted four-part left proximal humerus fracture with an irreducible posterior humeral head dislocation requiring urgent ORIF following a motor vehicle accident.
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Hong P, Rai S, Liu R, Tang X, Li J. Glenohumeral joint dislocation is rare in children with proximal humeral fractures: a descriptive study and literature review. BMC Musculoskelet Disord 2022; 23:36. [PMID: 34986817 PMCID: PMC8734332 DOI: 10.1186/s12891-021-04992-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Background Glenohumeral dislocation combined with fracture of the proximal humerus is extremely rare in children, and this study aims to investigate its incidence in the pediatric population and review the treatment strategy for this condition. Methods Between Jan 2014 and Jan 2019, 280 patients with unilateral proximal humeral fractures were retrospectively reviewed. Imaging and follow-up notes were reviewed for patients with a predilection for glenohumeral joint dislocation. Six (2.14%) patients between the ages of 5 and 10 years were confirmed as glenohumeral joint dislocation and included in the study. All these patients underwent closed reduction and external fixation under general anesthesia. Results Out of 280 patients with proximal humeral fractures, only 6 patients, including 4 males and 2 females, were confirmed as glenohumeral joint dislocation. ROM was normal compared with the contralateral shoulder in every patient at the last follow-up. There was no case of radiological abnormality, including avascular necrosis or devascularization of the humeral head. Conclusions Glenohumeral dislocation is a rare entity associated with the proximal humerus fracture in children, with an overall incidence in our case series was 2.14%. Reduction and stabilization of such injury using an external fixator is a suitable choice for pediatric patients that failed closed reduction.
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Affiliation(s)
- Pan Hong
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Saroj Rai
- Department of Orthopaedics and Trauma Surgery, Blue Cross Hospital, Tripureswor, Kathmandu, 44600, Nepal
| | - Ruikang Liu
- The First Clinical School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xin Tang
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jin Li
- Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Posterior Shoulder Dislocation with Engaging Reverse Hill-Sachs Lesion: A Retrospective Study of Ten Patients Treated with Arthroscopy or Open Reduction and Stabilization. J Clin Med 2021; 10:jcm10071410. [PMID: 33915791 PMCID: PMC8037443 DOI: 10.3390/jcm10071410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/09/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022] Open
Abstract
This study compares two surgical techniques used to treat patients with posterior shoulder dislocation with an engaging reverse Hill–Sachs lesion. We assessed ten patients who were treated at the Surgical Orthopedic and Traumatological Institute (ICOT) of Latina and the Clinic of Orthopedic and Traumatological Surgery of the ASST Sette Laghi of Varese between 2016 and 2019. The patients were divided into two groups: the first comprising six patients who underwent the open surgery McLaughlin procedure as modified by Neer, the second including four patients who underwent the arthroscopic McLaughlin procedure. All patients received postoperative rehabilitation to achieve the best possible functional recovery of the affected shoulder. We then assessed the shoulder range of motion, the pain level, and the impact on quality of life with four tests: the Constant Scale, the Simple Shoulder Test (SST), the OXFORD Scale, and The University of California—Los Angeles (UCLA) Shoulder Scale. The mean scores of the first group were: 81.3 ± 9.8 SD (Constant Scale), 10.8 ± 1.06 SD (SST), 42.5 ± 5.4 SD (Oxford Scale), 30.8 ± 3.02 SD (UCLA Shoulder Scale); we calculated the following mean scores in the second group: 80.25 ± 4.1 SD (Constant Scale), 11.5 ± 0.8 SD (SST), 42 ± 4.06 SD (Oxford Scale), 32 ± 2.9 SD (UCLA Shoulder Scale). We found no significant differences between the two groups.
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