Posterior Shoulder Dislocation Associated With the Head (Splitting) and Humeral Neck Fracture: Impact of Understanding Radiologic Signs and Experience With an Extended Deltopectoral Approach

Abstract

In this paper, our main objective was to emphasize the competency of extended deltopectoral exposure, enforced with the supraspinatus and subscapularis detachment, to gain access to the entire head. The second important point in this paper was to underline the importance of the knowledge that is necessary for interpreting classic radiologic signs of posterior fracture-dislocation of the shoulder. A 47-year-old woman fell down directly onto her shoulder while she was skiing. She was diagnosed with posterior shoulder dislocation, associated with fracture of the head (head splitting) and humeral neck fracture, with the aid of plain radiographs and computed tomographic results. The patient was treated with open reduction and internal fixation of the fracture, through the extended deltopectoral approach, which was augmented with rotator cuff detachment. At the 1-year follow-up, x-rays showed stable fixation with good evidence of healing. One year after the surgery, the patient had no pain, and she regained most of her functionality in her right shoulder with 140 to 150 degrees of lateral elevation (abduction), 140 to 150 degrees of forward flexion , internal rotation hand at T12 vertebra (slightly restricted). These results showed good functionality, with a painless shoulder at the 1-year follow-up. The "double shadow" and "lightbulb" signs are indicative of posterior shoulder fracture-dislocation, and augmented (with the detachment of supraspinatus and subscapularis tendons) traditional deltopectoral incision is suitable for managing these kinds of difficult fracture dislocations.

Reverse Shoulder Arthroplasty for Proximal Humerus Head-Split Fractures—A Retrospective Cohort Study

“…While complication rates for joint-preserving therapy options are high, young patients should be treated as soon as possible to minimize the risk of avascular necrosis [ 8 , 15 ]. High-impact trauma resulted in humeral head splitting that was first documented in dislocation fractures [ 4 , 6 , 8 , 24 ], yet we observed a collateral glenoid rim fracture in 5 out of 45 patients. We hypothesize that this is due to the trauma mechanism of the humeral head being forced against the glenoid, which causes the head-split fracture but may also result in glenoid rim fractures due to either extremely high shearing forces or poor bone quality.…”

A Case of Modified McLaughlin Procedure in Neglected Posterior Shoulder Fracture Dislocation

“…In a conventional radiograph of the shoulder, there is a half-moon appearance due to the over-imposition of part of the humeral head over the glenoid. Internal rotation of the humeral head in posterior shoulder dislocation seen on AP view is suggestive of a lightbulb sign [ 13 ]. If posterior locked fracture dislocation of the shoulder is suspected, a CT scan is usually done to assess the fracture anatomy and execute preoperative planning.…”

Luxofractura posterior bilateral de hombro secundaria a episodio de convulsión: importancia del diagnóstico oportuno. A propósito de un caso

“…Signos clásicos como el de la «ampolleta» o el de la «glena vacía» no son identificados con frecuencia en la proyección anteroposterior de hombro. 13,14 Sin embargo, se han reportado tasas diagnósticas de hasta 100% con el uso de radiografía cuando se incluye una proyección axilar o velpeau. 6 En el caso presentado, la incorporación de estas radiografías desde el ingreso pudo haber evitado el retraso diagnóstico de 48 horas y posiblemente prevenido el agravamiento observado de la lesión.…”