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Posterior fracture-dislocation of the humeral head is an uncommon injury, usually associated with seizures, electrocution injury and high-impact trauma. Prompt diagnosis and treatment are important to prevent avascular necrosis of the humeral head. Various methods to treat such injury have been described. We report a 34-year-old man who had a four-...
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Posterior shoulder dislocation is an uncommon injury that typically follows intense contraction of the external rotator muscles, such as from seizure activity, high-velocity trauma, or intense electrical shock. The diagnosis is often missed or delayed, leading to complications such as functional deficits or osteonecrosis of the humeral head. Closed...
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... Because of the rarity of this nosological entity and of different osteocartilaginous and capsololigamentous injuries that can be associated with posterior fracture dislocation, there is no Medicina 2023, 59, 772 2 of 10 uniformity of thought in the literature regarding how to manage it. In fact, a vast array of conservative or surgical treatments have been proposed: reduction of the dislocation and conservative treatment [2,5,22]; reduction and osteosuture [23]; reduction and anatomical reconstruction for reverse Hill Sachs lesion with bone graft [24,25]; classical or modified McLaughlin procedure [10,[26][27][28][29]; reduction and synthesis with Kirschner/Steinmann wires [3,9,30,31] or with free screws [1,5,16,32]; reduction and synthesis with plate and screws [1,3,6,11,14,[33][34][35][36]; humeral surface replacement [37]; hemiarthroplasty [2,6,10,15,31,33,38]; or arthroplasty [39]. ...
... Unfortunately, it is difficult to easily interpret the literature data relating to the results obtained with surgical treatment because the various series are each made up of few cases and the patients included in the studies have often different initial anatomopathological pictures. Furthermore, the uncertainty is amplified by the fact that there is no uniformity of thought regarding: (1) how to treat the posterior fracture dislocation and, consequently, which type of surgical approach has to be used (deltopectoral [3,16,[23][24][25][26][28][29][30]32,36,37,47], deltoid splitting [35], superior subacromial [4], vertical posterior [4,13,31], horizontal posterior [39], combined anterior and posterior [4,11,14], axillary [9] approach); (2) how to relocate the humeral head into the glenoid fossa (manually or by means surgical instruments that could cause further cartilage damage); and (3) how to fix the fracture dislocation (sutures, plates, K wires, screws) when the hypothesis of a prosthesis implant is not considered. ...
Background and Objectives: Posterior fracture dislocations are rare. There is currently no uniformity regarding treatment. Therefore, outcomes are difficult to compare. We evaluated clinical and radiological outcomes of patients with humeral head posterior fracture dislocation treated with an open posterior reduction and then fixed with a biomechanically validated configuration of blocked threaded wires. Materials and Methods: 11 consecutive patients with humeral head three-part posterior fracture dislocation were treated by reduction through a posterior approach and fixed with blocked threaded wires. All patients were clinically and radiographically evaluated after a mean follow-up of 50 months. Results: The mean irCS was 86.1% (range: 70.5–95.3%). No significant difference was found between irCS at 6 and 12 months postoperatively and the final follow-up. Six patients noted their pain intensity as 0/10, three as 1/10, and two as 2/10. The postoperative reduction was considered as excellent in eight patients (Bahr’s criteria) and good in the remaining three; at the final follow-up, reduction was excellent and good in seven and four patients, respectively. The mean neck-shaft angles at FU 0 and at the final FU were 137° and 132°, respectively. No signs of avascular necrosis, non-union, and arthritis progression were seen. No recurrence of dislocation or posterior instability symptoms were reported. Conclusions: We believe that our very satisfactory results stem from: (1) the manual reduction of the dislocation through a vertical posterior surgical approach, which does not produce further osteocartilaginous damage of the humeral head; (2) no multiple perforations of the humeral head are performed; (3) the threaded wires have a smaller diameter than the screws, therefore they preserve the bone tissue of the humeral head; (4) deperiostization or further detachment of soft tissues are not expected; (5) the adopted and validated system is stable and limits translation, torsion, and the collapse of the humeral head.
... For smaller defects, the McLauglin procedure [23,25] or a modification [26] thereof is well established in treating the humeral head injury. Other morcelised bone grafting and fixation techniques [27][28][29] have been reported as well showing a varied approach in dealing with these injuries. In the frequent situation where the diagnosis of these injuries is delayed, open reduction can result in poor outcomes due to the occurrence of secondary post-traumatic osteoarthritis [30]. ...
ement. The injuries are often overlooked at initial presentation due to low index of suspicion by often inexperienced medical staff. High proportions of these injuries are missed on initial radiographic assessment, leading to late presentation of locked posterior fracture dislocation of the shoulders requiring salvage procedures in an attempt to restore shoulder function.
Four patients presented to a large regional hospital with bilateral posterior fracture dislocations of the gleno-humeral joint over a twelve-month period. We present a brief case synopsis for each patient and present functional outcome results for the surviving pa- tients at a minimum of twelve months follow-up. A management algorithm is suggested for those patients that may require surgery.
... In the presence of complex fracture-dislocations, fragmentation of humeral head and tuberosities is another factor to be considered prior to operation (Fig. 1). Only a few case studies can be found in the literature dealing with this type of injury proposing mostly minimal invasive osteosynthesis techniques [47,[50][51][52][53]. Internal fixation increases the probability of osteonecrosis of the humeral head and non-union, but persistent dislocation of the humeral head and chronic lesser tuberosity fracture are worse predictors of the postoperative rate of avascular necrosis [52,54,55]. ...
Posterior shoulder fracture–dislocation is a rare injury accounting for approximately 0.9 % of shoulder fracture–dislocations. Impression fractures of the articular surface of the humeral head, followed by humeral neck fractures and fractures of the lesser and grater tuberosity, are the more common associated fractures. Multiple mechanisms have been implicated in the etiology of this traumatic entity most commonly resulting from forced muscle contraction as in epileptic seizures, electric shock or electroconvulsive therapy, major trauma such as motor vehicle accidents or other injuries involving axial loading of the arm, in an adducted, flexed and internally rotated position. Despite its’ scarce appearance in daily clinical practice, posterior shoulder dislocation is of significant diagnostic and therapeutic interest because of its predilection for age groups of high functional demands (35–55 years old), in addition to high incidence of missed initial diagnosis ranging up to 79 % in some studies. Several treatment options have also been proposed to address this type of injury, ranging from non-surgical methods to humeral head reconstruction procedures or arthroplasty with no clear consensus over definitive treatment guidelines, reflecting the complexity of this injury in addition to the limited evidence provided by the literature. To enhance the literature, this article aims to present the current concepts for the diagnosis, evaluation and treatment of the patients with posterior fracture–dislocation shoulder, and to present a treatment algorithm based on the literature review and our own experience.
... The mean length from injury to the surgery was 40 days (11). In the Tey study (2007) in Singapore, posterior fracture-dislocation of the shoulder has treated without using metallic implants (12). The good results have obtained from a 34-year-old patient with posterior fracture-dislocation for whom the deltopectoral shoulder approach and open reduction have been used and nonabsorbable polyester has been used for lesser tuberosity fixation (12). ...
... In the Tey study (2007) in Singapore, posterior fracture-dislocation of the shoulder has treated without using metallic implants (12). The good results have obtained from a 34-year-old patient with posterior fracture-dislocation for whom the deltopectoral shoulder approach and open reduction have been used and nonabsorbable polyester has been used for lesser tuberosity fixation (12). The accurate understanding of the locked posterior dislocation is crucial, since in such cases, the reduction can be unsuccessful (6). ...
... In the Ben-David study, 50% of the 22 cases have been improved through a year (13). It seems that using additional imaging procedures can be helpful in the posterior fracture-dislocation for the accurate diagnosis of the locked fracture-dislocation cases (12). According to Richards RR reports, a brachial plexus injury occurs after shoulder instability treatment, especially after a Putti-Platt Arch Trauma Res. ...
Introduction: Posterior shoulder dislocation associated with fracture of the lesser tuberosity is considered as a rare shoulder trauma. It can lead to the locked shoulder with a very high possibility of unsuccessful closed reduction.
Case Presentation: In this case, the patient was a 30-year-old male motorcyclist with the right shoulder injury who had posterior shoulder dislocation with lesser tuberosity fracture. Early attempt for closed reduction was unsuccessful and led to iatrogenic brachial plexus injury. This patient is treated by open reduction and fracture fixation with screw. Subscapularis partial rupture was repaired. Finally, full stability was achieved.
Conclusions: Fracture fixation plays a crucial role in stability after reduction. Several techniques have been suggested for surgical treatment including fixation with screw and the modified McLaughlin technique. Similar to the previous case reports, according to our experience, careful attention to the fracture concomitant with posterior dislocation is of the utmost importance.
Keywords: Posterior Fracture Dislocation; Lesser Tuberosity Fracture; Reverse Hill-Sachs Lesion
... [5][6][7][8][9] La reducción de la luxación debe llevarse a cabo tan pronto como sea posible para disminuir al mínimo la lesión vascular de la cabeza humeral que puede conducir a la osteonecrosis y al posterior colapso. 9,10 No obstante, si bien la perfusión del fragmento de la cabeza es un elemento esencial, no es el único para la toma de decisiones. A pesar de una cabeza isquémica, un tratamiento de preservación es una opción cuando es esperable la revascularización o cuando se requiere un protocolo de gestión de dos etapas (primera etapa, la osteosíntesis; segunda etapa, la hemiartroplastia si la necrosis avascular no es tolerada). ...
Re ci bi do el 3-2-2014. Aceptado luego de la evaluación el 27-5-2014. Co rres pon den cia: Dr. IGNACIO ARZAC ULLA Hombre de 52 años de edad, sin antecedentes de rele-vancia, que consultó por dolor e impotencia funcional de miembro superior derecho, debido a una descarga eléctri-ca de un artefacto doméstico que estaba reparando. Refi-rió que, luego de la descarga, no cayó de su propia altura ni sufrió traumatismo del miembro afectado. Se encon-traba en buen estado general y no tenía quemaduras en el cuerpo. En la exploración física, se detectó contractura de la musculatura escapulo-humeral e impotencia funcional. No tenía déficits sensitivo ni motor. Se solicitaron radiografías de frente, axial y tomografía computarizada de miembro superior derecho, que mos-traron una luxofractura anterior escapulo-humeral (Figs. 1-3). El paciente fue internado y se realizaron estudios que descartaron trastornos metabólicos y del ritmo cardíaco. A las 12 horas del ingreso, se efectuó la reducción ce-rrada de la luxación (Fig. 4) y se programó la hemiar-troplastia que consistió en la colocación de una prótesis tipo Neer a través de un abordaje deltopectoral con repa-ración de las tuberosidades. El paciente evolucionó favo-rablemente, con un puntaje DASH de 20,8 y un rango de movilidad de flexión anterior de 100°, abducción de 90°, extensión de 20°, rotación interna de 85° y rotación exter-na de 10°, a los 18 meses de la cirugía. Discusión Las fracturas por electrocución son poco comunes y, en su mayoría, se producen por traumatismos directos o caí-das al suelo. Sin embargo, hay casos publicados en los que las fracturas o fracturas luxaciones pueden producirse por espasmo muscular inducido por la corriente eléctrica. 1-3 La articulación del hombro es la que resulta afectada con más frecuencia por luxaciones, el 2% son posteriores, el 98% restante son anteriores y el 1% se asocia a fractu-ras. 1,4,5 La luxación del hombro puede ser unilateral o bilateral, anterior o posterior. Las bilaterales y posteriores son rela-tivamente raras. Figura 1. Radiografía de hombro, de frente, que muestra una luxofractura del húmero proximal.
... The risk of missing PD can be minimized by careful physical examination. In these patients before X-Ray CT should be performed to better delineate the anatomy of the fracture dislocation and enable the planning of surgery (7). The standard AP view looks normal or shows only subtle abnormalities. ...
Posterior shoulder dislocations are rare and often missed. Classically associated with seizures, very little is known about the incidence and type of associated injuries. Unfortunately, the majority of the literature consists of incidental reports or small case series. Our goal was to increase the strength of available data by performing a systematic review.
We searched EMBASE and PubMed for the terms "posterior shoulder dislocation." Our inclusion criteria were articles in either English or French with the words "posterior" and "dislocation" in the abstract or title. All reports of chronic cases or instability as well as those without patient information were excluded. Data regarding demographics, etiology, investigations, associated injuries, treatments, and outcomes were extracted. All data were analyzed by using SPSS 18.0 (IBM, Chicago, IL).
A total of 766 articles were found of which 108 were retained for analysis. A total of 475 patients (543 shoulders) were compiled. Seizures were reported in 34% of cases. A majority of dislocations (65%) had associated injuries. Fracture was most common followed by reverse Hill-Sachs and cuff tears. In the absence of fracture or reverse Hill-Sachs injury, the risk of cuff tear increased nearly fivefold (odds ratio, 4.6; P = 0.016).
Our results suggest the amount of associated injuries related to posterior shoulder dislocation is far greater than thought. We propose an investigation algorithm for acute posterior shoulder dislocations.
