Posterior shoulder fracture–dislocation: an update with treatment algorithm

Abstract

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.

Posterior shoulder dislocation: it’s worth another look

“…Clinicians should be wary of the possibility of the presence of another injury if the patient’s symptoms are out of proportion with what one would expect from the apparent injury. One of the main reasons for missing PSD is that a lateral axillary radiograph is not taken,1 as was the case in this patient.…”

“…Missed initial diagnosis of posterior shoulder dislocation has been as high as 79% in some studies, with some cases going unrecognised for months 1. In comparison, a clavicle fracture is a relatively common finding.…”

“…Posterior shoulder joint dislocation (PSD) is rare, accounting for only 2%–5% of all shoulder dislocations 1. PSD injuries are also frequently missed, which can lead to a significant morbidity in the affected patient.…”

Open reduction through a posterior incision in the surgical treatment of shoulder posterior dislocation associated with proximal humeral fractures

“…Chronic posterior dislocation usually associated with reverse Hill‐Sachs lesions need to be openly reduced through the deltopectoral approach . Posterior dislocation of the shoulder associated with proximal humeral fracture is a more rare injury accounting for approximately 0.9% of shoulder fracture‐dislocations . In this type of fracture, dislocation of the humeral head and the humeral shaft are not in contact and, in some cases, the greater tuberosity and lesser tuberosity are also in a state of separation.…”

Mclaughlin Procedure Treatment of Bilateral Sequential Posterior Dislocation Fracture of the Shoulder: A Case Report

“…According to this algorithm surgical and nonsurgical technics are described. They proposed to decide the management according to factors as described above 15. In our patient after an epileptic seizure PSD was seen.…”