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Bilateral anterior dislocation of the shoulders with proximal humeral fractures: a case report.

Bilateral simultaneous anterior dislocation of the shoulders with bilateral 3-part fracture of the proximal humeri is unusual. A 42-year-old man presented with pain and restriction of movement on both shoulders. He was injured by a heavy object falling over his back while he was leaning forward holding an overhead bar. His arms were abducted and externally rotated. The injury was not correctly diagnosed, and the patient was treated with repeated manipulations and splintage for 2 weeks. Radiological examination revealed bilateral anterior dislocation of the shoulders with displaced 3-part fractures of the proximal humeri involving the shaft, greater tuberosity, and head. The patient was treated with open reduction and internal fixation through a deltopectoral approach using multiple Kirschner wires. The shoulders were kept immobilised for 3 weeks until the removal of the wires. The patient was able to resume work 3 months after surgery. He had an excellent and comfortable range of motion in both shoulders at one-year follow-up.

Adult↗

Posterior dislocation and fracture-dislocation of the shoulder.

Two cases of posterior dislocation (PD) and four cases of posterior fracture-dislocation (PFD) of the shoulder are reported. There was one bilateral PD and two bilateral PFD. One PD was treated with closed reduction but in three cases of PFD operative reduction was necessary. All measures were applied in the late phase within 1 to 10 months after the injury with good primary results. However, because of posttraumatic arthrosis, the final result was poor. The average follow-up period was 4 years. The diagnosis of posterior dislocation is often missed. An axillary X-ray is essential.

Adolescent↗

Bilateral posterior fracture-dislocations of the shoulder after convulsive status epilepticus.

Presented is the case of a 30-year-old man who sustained bilateral posterior fracture-dislocations of the shoulder as an unusual complication of status epilepticus. Initial evaluation failed to reveal this unsuspected diagnosis. After improvement in the patient's mental status, his subjective complaints made the diagnosis evident. He subsequently underwent hemiarthroplasty for one shoulder and active assisted range of motion exercises for the other, with partial return of function in both arms.

Adult↗

[Triple fracture of the superior shoulder suspensory complex].

The authors present the case of a displaced fracture of the coracoid process associated with a displaced fracture of the acromion, an undisplaced fracture of the clavicule and fractures of the first to fifth ribs. Open reduction of the coracoid process fracture was performed. At the last follow-up, the coracohumeral distance was restored (10 mm), but the acromiohumeral distance in the sagittal place was decreased (5 mm). The authors recommend open reduction of displaced fractures around the rotator cuff to limit the risk of impingement between the cuff and the coracoid process or the acromion.

Acromion↗

A spontaneous relocation of a dislocated Neer prosthesis. Occurs with recovery of brachial plexus lesion.

A 52-year-old man incurred a brachial plexus injury with a two-part anterior fracture dislocation of the shoulder. The fracture was converted to a four-part fracture dislocation during attempts to reduce the initial lesion in a closed fashion. The four-part fracture dislocation was treated with a Neer humeral head replacement. Postoperatively, the prosthesis gradually dislocated inferiorly and relocated spontaneously with the recovery of the brachial plexus lesion.

Brachial Plexus↗

[The arteries of the humerus and their relevance in fracture treatment].

BACKGROUND: The purpose of the current work was to study the arterial blood supply of the humerus to evaluate impairments of the blood supply after humeral fractures and different methods of fracture treatment. METHODS: Arterial blood supply of the humerus was studied by corrosion injection technique in 6 cadaver preparations and is compared with the existing literature. RESULTS: Humeral head arteries originate from the circumflex humeral arteries. The major vessel enters the greater tubercle. Another group of vessels accesses the head from medially. The nutrient artery for the shaft enters into the medial third of the shaft. At the distal humerus there are multiple anastomoses with penetrating branches into both condyles and proximal to the radial, coronoid, and olecranon fossae. CONCLUSIONS: Fragments of a proximal humeral fracture usually have an independent blood supply. The medial vessels to the head gain high importance in fractures of the anatomical neck. The nutrient artery lies regularly medial to the humeral mid-shaft and is at risk at open reduction of this region. The abundant vessels at the entire distal humerus ensure sufficient vascularization of the fragments after fracture.

Arteries↗

The Velpeau bandage.

Many varieties of swaddling bandages for injuries of the shoulder are in use and are called Velpeau bandages. Velpeau's original description has been consulted. The injured arm is placed across the chest and turns of bandage are made from beneath the sound axilla, over the injured shoulder, in front of the injured arm, and beneath the elbow, to pass again to the sound axilla. It is completed by transverse turns. Velpeau, a blacksmith's son, was born in 1795, became professor of surgery in Paris, and died in 1867 after a distinguished career.

Axilla↗

Surgical treatment of acute and chronic posterior fracture-dislocation of the shoulder.

Seventy-three shoulders (66 patients) with posterior fracture-dislocation of the shoulder were treated. Thirty patients were treated during the acute phase. One case was classified as subspinous, and 56 were considered subacromial; 4 cases had posterior fracture-dislocation in three parts, 3 in four parts, and 9 at the anatomic neck. Treatment consisted of closed reduction and immobilization in the emergency department, McLaughlin's procedure, hemiarthroplasty, total shoulder, open reduction with internal fixation, arthroplastic resection, and arthrodesis. Ten shoulders were treated conservatively. The University of California-Los Angeles rating score was used to analyze 56 shoulders during a mean follow-up period of 32.7 months. Good and excellent results can be achieved in those cases that are treated up to 2 years of the lesion; after 2 years results tend to be fair. We do not suggest total shoulder arthroplasty as a treatment option for those surgeons without the necessary expertise.

Acute Disease↗

Influence of the design of the prosthesis on the outcome after hemiarthroplasty of the shoulder in displaced fractures of the head of the humerus.

We reviewed 39 patients with displaced three- and four-part fractures of the humerus. In 21 patients (group A) we had used an anatomical prosthesis for the humeral head and in 18 (group B) an implant designed for fractures. When followed up at a mean of 29.3 months after surgery the overall Constant score was 51.9 points; in group A it was 51.5 and in group B 52.4 points. The subjective satisfaction of the patients was assessed using a numerical rating scale and was similar in both groups. In group A complete healing of the tuberosities was found in 29% and 50% in group B. Partial integration was seen in 29% of group A and in only one patient in group B, while resorption was noted in 43% of group A and 44% of group B. The functional outcome was significantly better in patients with complete or partial healing of the tuberosities (p=0.022). The specific trauma prosthesis did not lead to better healing of the tuberosities. The difference in clinical outcome obtained by the two designs did not reach statistical significance.

Aged↗