Irreducible Anterior Shoulder Dislocation Associated With Displaced Fracture of the Greater Tuberosity: An Analysis of Seven Cases

Abstract

Background: Although anterior shoulder dislocation is the most prevalent type of body dislocation, irreducible anterior shoulder dislocation is seldom reported in the literature, which is usually due to physical obstacles. Objectives: This study presents our findings regarding the causes of irreducibility of anterior shoulder dislocation associated with displaced fracture of the greater tuberosity. Patients and Methods:CT scans, open reduction of the joint, and internal fixation of the tuberosity was performed in seven patients with irreducible anterior shoulder dislocation associated with displaced fracture of the greater tuberosity. Results: As confirmed by intraoperative findings, the CT scans showed the cause of irreducible shoulder dislocation in six cases was the interposition of the long head of biceps (LHB) in the anterior of the head that was displaced from the fracture line between the greater and lesser tuberosities. In another case, the greater and lesser tuberosities were attached to each other and were separated from the head. This fractured part was trapped. Conclusions: We suggest that performing CT scans in all cases of anterior shoulder dislocations with displaced fracture of the greater tuberosity can help surgeons to diagnose the accompanying fractures and possible complications, such as irreducibility. If the fracture line passes through the bicipital groove or in the case of a shield fracture, possible irreducibility should be borne in mind.

Irreducible Anterior Shoulder Dislocation with Interposition of the Long Head of the Biceps and Greater Tuberosity Fracture: A Case Report and Review of the Literature

“…Plain anteroposterior and true lateral scapular views are usually adequate; Stryker notch view, although difficult to obtain, can identify small Hill-Sachs lesions. CT with 3D reconstruction provides an accurate demonstration of the injury facilitating the reduction technique using the appropriate maneuvers [15, 33]. In our case, CT-scan was temporarily unavailable at the time of admission but considering the course of the disease and the need for open reduction we don’t believe that this exam would offer any additional benefit to the final outcome.…”

“…Nakhaei Amroodi M [15] reported on 7 patients; 6 had greater tuberosity fracture and LHBT interposition and one a “shield” greater and lesser tuberosity fracture interposed by subscapularis and infraspinatus tendons. Seradge H & Orme G [7] reported on 3 cases with 3 different mechanisms of obstruction; the rest 20 reports concerned single cases only.…”

“…Interposition of the LHBT alone or in combination with greater tuberosity fracture was the most common obstacle to reduction [5, 7, 9, 11-16], followed by subscapularis tendon interposition either tightened around the humeral head or as soft tissue hindrance inside glenoid [17, 19-24]. Other reasons for an unsuccessful closed reduction were the interference of bony fragments [18, 25] or the labrum [7] inside glenoid, the presence of a “shield” fracture of both tuberosities [15], interposition of the musculocutaneus nerve [26] and two cases of anterosuperior dislocation with torn rotator cuff and the humeral head lying underneath deltoid muscle [8, 10]. …”

Irreducible Traumatic Posterior Shoulder Dislocation

“…However, definitive diagnosis is made by the "Y" view which shows the humeral head displaced posteriorly and no longer covering the glenoid fossa. 6 Irreducible acute posterior dislocation of the shoulder is extremely rare 5 and only one other case has been reported in the literature. 7 Topics: Posterior shoulder, reverse Hill-Sachs, irreducible, ortho, orthopedics, shoulder dislocation.…”

Evaluation of Recurrence Rate and Risk Factors Affecting Recurrence of Recurrent Shoulder Dislocation in Kashani Hospital in 2017-2018

“…In a study, the presence of a defect in the glenoid cavity and relaxation of the ligaments, especially young and professional athletes, were mentioned as risk factors for recurrent dislocation [4,5]. In another study, 75% of those treated conservatively had recurrent dislocations, compared with 11% of those who underwent surgery.…”