J Korean Fract Soc.  2016 Jan;29(1):50-54. 10.12671/jkfs.2016.29.1.50.

Iatrogenic Humeral Fracture during Reduction of Shoulder Dislocation: Two Cases Report

• Cho HL
• Kim HM
• Park KB
• Wang TH
• Lee DH

• KMID: 2183765
• DOI: http://doi.org/10.12671/jkfs.2016.29.1.50

Abstract

Shoulder dislocation is the most common dislocation presenting to the emergency department. In old age, the attempt of closed reduction is made with caution in order to prevent iatrogenic fracture around the shoulder. We report two cases of iatrogenic fractures of humeral shaft and anatomical neck in female patients older than 70 years old, which occurred during the manual closed reduction. One patient was proved as first-time and the other was recurrent. In addition, the second case had a massive irreparable rotator cuff tear. Those patients were treated successfully with humeral nailing and reverse total shoulder arthroplasty, respectively.

Keyword

Shoulder dislocation; Humerus fracture; Intramedullary nailing; Reverse total shoulder arthroplasty

MeSH Terms

Arthroplasty
Dislocations
Emergency Service, Hospital
Female
Fracture Fixation, Intramedullary
Humans
Humeral Fractures*
Neck
Rotator Cuff
Shoulder Dislocation*
Shoulder*
Tears

Figure

• 

  Fig. 1 (A, B) Shoulder radiographs show a subglenoid type of anterior glenohumeral dislocation. (C) The humeral shaft fracture occurred when attempting closed reduction detected in a post reduction radiograph. (D) A radiograph taken five months later shows fixation with humeral nailing. Postoperatively, dislocation was reduced and there were no specific complications. Bone union was observed at 5 months of final follow-up.

• 

  Fig. 2 (A, B) Shoulder radiographs show a subacromial type of anterior glenohumeral dislocation. (C) Anterior dislocation with humeral anatomical neck fracture was observed on 3-dimensional computed tomography images. (D) Intraoperative photograph shows a humeral anatomical neck fracture. (E) Coronal oblique, T2-weighted magnetic resonance imaging (MRI) scan of a full thickness tear and medial retraction of the supraspinatus tendon (white arrow). (F) And supraspinatus muscle (SSP) with Goutallier classification grade III was seen on a sagittal, T1-weighted MRI scan. (G, H) Postoperative with a reverse total shoulder arthroplasty (Zimmer, Cowpens, SC, USA) 4 months later, radiograph and clinical photograph, there were no specific complications and favorable range of motion of the right shoulder was gained at 4 months of follow-up.

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