Fractured coracoid with anterior shoulder dislocation and greater tuberosity fracture--report of a bilateral case

Background: Failure of closed manipulative reduction of an acute anterior shoulder dislocation is seldom reported in the literature and is usually due to structural blocks such as soft tissue entrapment (biceps, subscapularis, labrum), bony fragments (glenoid, greater tuberosity) and severe head impaction (Hill-Sachs lesion). Case report: We present a case of an irreducible anterior shoulder dislocation in a 57-year-old male patient after a road-traffic accident. He had severe impaction of the head underneath glenoid rim and associated fracture of the greater tuberosity. Closed reduction performed in the emergency room under sedation and later at the theatre under general anaesthesia was unsuccessful. Open reduction using the dectopectoral approach revealed that the reason for obstruction was the posterolateral entrapment of the biceps tendon between the humeral head and the tuberosity fragment. Reduction was achieved after subscapularis tenotomy and opening of the joint; the tuberosity fragment was fixed with transosseous sutures and the long head of the biceps tendon was tenodesized. The patient had an uneventful postoperative recovery and at his last follow up, 12 months postoperatively, he had a stable joint, full range of motion and a Constant score of 90. Conclusion: A comprehensive literature review revealed 22 similar reports affecting a total of 30 patients. Interposition of the LHBT alone or in combination with greater tuberosity fracture was the most common obstacle to reduction, followed by subscapularis tendon interposition and other less common reasons. Early surgical intervention with open reduction and confrontation of associated injuries is mandatory for a successful outcome.

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A surge in neglected shoulder dislocations and delayed surgical management due to the coronavirus disease 2019 lockdown in India

Clinics in Shoulder and Elbow ◽

10.5397/cise.2021.00255 ◽

2021 ◽

Vol 24 (4) ◽

pp. 265-271

Author(s):

Dipit Sahu ◽

Arun Gupta ◽

Samarjit S. Bansal

Keyword(s):

Surgical Management ◽

Shoulder Dislocation ◽

Proximal Humerus ◽

Fracture Dislocation ◽

Anterior Shoulder Dislocation ◽

Greater Tuberosity ◽

Greater Tuberosity Fracture ◽

Travel Restrictions

Four patients with shoulder problems that were traumatic in etiology presented to us with delays in seeking care ranging from 6 to 12 weeks due to the coronavirus disease 2019 (COVID-19) lockdown. The care of three cases (a 3-month-old neglected anterior shoulder dislocation with a greater tuberosity fracture in a 30-year old man, a 3-month-old neglected anterior shoulder dislocation in a 17-year old boy, and a 2-month-old neglected greater tuberosity fracture in a 31-year old man) was delayed due to the lockdown and the ensuing travel restrictions, while that of one case (a 6-week-old fracture–dislocation of the proximal humerus in a 55-year-old woman) was delayed because the patient was undergoing treatment for COVID-19 at the time of injury. This report intends to present the exceptional circumstances around these cases. The unique treatment challenges and their outcomes are also described to advise the surgeons of the nuances and difficulties in treating these injuries.

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Accompanying Lesions and Clinical Results in the Greater Tuberosity Fracture of the Humerus with Anterior Shoulder Dislocation Under the Age of Forty

Clinics in Shoulder and Elbow ◽

10.5397/cise.2011.14.1.020 ◽

2011 ◽

Vol 14 (1) ◽

pp. 20-26

Author(s):

Doo-Sup Kim ◽

Yeo-Seung Yoon ◽

Dong-Kyu Lee ◽

Hyeun-Kook Park ◽

Jang-Hee Park ◽

...

Keyword(s):

Shoulder Dislocation ◽

Clinical Results ◽

Anterior Shoulder Dislocation ◽

Greater Tuberosity ◽

Greater Tuberosity Fracture

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Paper # 24: Arthroscopic Treatment of Anterior Shoulder Dislocation with Displaced Greater Tuberosity Fracture

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2011.08.025 ◽

2011 ◽

Vol 27 (10) ◽

pp. e86

Author(s):

Rickson Moraes ◽

Bruno Lobo Brandão ◽

Mario Pacheco ◽

Marcio Cohen ◽

Marcus Vinicius Galvão Amaral ◽

...

Keyword(s):

Shoulder Dislocation ◽

Arthroscopic Treatment ◽

Anterior Shoulder Dislocation ◽

Greater Tuberosity ◽

Greater Tuberosity Fracture

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Reducing Shoulder by Vertical Traction: A One-Man Method for Shoulder Reduction

Advances in Orthopedic Surgery ◽

10.1155/2016/9301869 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Hayat Ahmad Khan ◽

Younis Kamal ◽

Mohammad Ashraf Khan ◽

Munir Farooq ◽

Naseemul Gani ◽

...

Keyword(s):

Emergency Department ◽

Learning Curve ◽

Shoulder Dislocation ◽

Anterior Shoulder Dislocation ◽

Greater Tuberosity ◽

Traction Method ◽

Joint Dislocations ◽

Good Technique ◽

Recurrent Shoulder Dislocation ◽

Glenohumeral Dislocation

Fifty percent of joint dislocations reported to the emergency department are of shoulder joint. Various techniques are used to reduce the shoulder and Spaso technique is the least known to the orthopaedic residents which is a simple one-man vertical traction method of shoulder reduction. We evaluated the effectiveness of vertical traction method for anterior shoulder dislocation by orthopaedic residents. Sixty consecutive patients of anterior glenohumeral dislocation attending the emergency department of our hospital were taken up for the study. The reduction was done using Spaso technique. Right shoulder was dislocated in 40 patients and 31 patients had recurrent shoulder dislocation. In 55 patients, shoulder was reduced without the use of any anaesthesia. In patients where no anaesthesia was used, the time of traction ranged from 45 seconds to 5 minutes, while under anaesthesia the time of traction ranged from 1 to 4 minutes. Twenty-one patients had associated greater tuberosity fracture which did not affect the method of reduction and all of them were reducible. No complication was reported, and all the patients were satisfied with the method. In conclusion vertical traction method is a good technique for reducing anterior shoulder dislocation with an easy learning curve among the residents and no complication has been reported so far.

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Anterior Shoulder Dislocation with Greater Tuberosity Frature of Humerus with Brachial Plexus Injury

Journal of Orthopaedic Education ◽

10.21088/joe.2454.7956.2116.5 ◽

2016 ◽

Vol 2 (1) ◽

pp. 21-24

Author(s):

R.B. Uppin ◽

◽

Samarth P. Shah ◽

Keyword(s):

Brachial Plexus ◽

Shoulder Dislocation ◽

Brachial Plexus Injury ◽

Anterior Shoulder Dislocation ◽

Greater Tuberosity

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The Efficacy of External Rotation Method for The Reduction of Acute Anterior Shoulder Dislocation With and Without Greater Tuberosity Fracture

Birat Journal of Health Sciences ◽

10.3126/bjhs.v3i2.20935 ◽

2018 ◽

Vol 3 (2) ◽

pp. 408-412 ◽

Cited By ~ 1

Author(s):

Gopal Prasad Gnawali ◽

Indra Dhakal ◽

Kishor Khatri ◽

Shanta Sharma

Keyword(s):

Shoulder Dislocation ◽

External Rotation ◽

Reduction Process ◽

Anterior Dislocation ◽

Emergency Setting ◽

Anterior Shoulder Dislocation ◽

Greater Tuberosity ◽

Rotation Method ◽

Cause Of Failure ◽

Successful Reduction

Introduction: Several methods of reduction technique have been described for the anterior dislocation of shoulder but none technique is said to be ideal. The aim of this study was to show the efficacy of external rotation method which could be safe and painless method for the reduction of the acute anterior shoulder dislocation with or without fracture of the greater tuberosity and to search the cause of failure of reduction.Objective: Objective of this study was to assess the efficacy of the external rotation method for reduction of acute anterior shoulder dislocation and to find the cause of failure of reduction.Methodology: All cases of anterior dislocation encountered in emergency department reduced by external rotation method by consultant orthopedic surgeon using basic emergency setting for resuscitation were included in the study. Fifty cases of shoulder dislocation was treated by this method and prospective evaluation done with regard to type of dislocation, the effectiveness of the procedure in achieving reduction, the need for pre-medication, the ease of performing reduction and complication if any.Results: Out of 50 cases, successful reduction was achieved in 42 patients. Premedication was not required in 36 successful reduction. Average time of reduction was 2 minutes in 30 patients and 5 minutes in 8 patients. Four Patients complained severe pain during reduction process. This method was not successful in 8 patients 2 of whom had displaced greater tuberosity fracture.Conclusion: The external rotation method is reliable and safe method for the reduction of acute anterior shoulder dislocation which can be performed relatively with less pain for both subcoracoid and subglenoid dislocation provided there is no displaced fracture of the greater tuberosity. BJHS 2018;3(2)6: 408-412.

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