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PubMed2004

Clinical factors predicting fractures associated with an anterior shoulder dislocation.

OBJECTIVES: To identify risk factors for fractures associated with an anterior shoulder dislocation treated in an emergency department (ED). METHODS: A retrospective case-control study over five years of patients with an anterior shoulder dislocation was accomplished in a university-affiliated ED. Chart review identified possible predictors of fractures. Comparing the profile of patients having a clinically important fracture associated with their shoulder dislocation (cases) with those sustaining a noncomplicated dislocation (controls) provided the outcome measure. RESULTS: A total of 334 patients were included in the study. Eighty-five (25.5%) had a clinically important fracture-dislocation, and the remaining 249 (74.5%) sustained a noncomplicated shoulder dislocation. Chi-square, logistic regression, and recursive partitioning analysis showed three significant factors for the presence of fracture-dislocation: 1) age 40 years or older, 2) a first episode of dislocation, and 3) mechanism of injury (i.e., a fall greater than one flight of stairs, a fight/assault episode, or a motor vehicle crash). A multiple logistic regression model estimated the significant adjusted odds ratios (and their 95% confidence intervals [95% CIs]) for each of the three factors: 5.18 (95% CI = 2.74 to 9.78), 4.23 (95% CI = 1.82 to 9.87), and 4.06 (95% CI = 1.95 to 8.48), respectively. A predictive model using any one of the three factors reached a sensitivity of 97.7% (95% CI = 91.8% to 99.4%), a specificity of 22.9% (95% CI = 18.1% to 28.5%), and a negative predictive value of 96.6% (95% CI = 88.3% to 99.6%). CONCLUSIONS: Three risk factors predict clinically important fractures that are associated with shoulder dislocation: age, first episode, and mechanism of dislocation. A prospective validation may lead to standardized use of prereduction radiographs of the shoulder in the ED.

Accidental Falls↗
PubMed1990

[Unreduced posterior luxations and fractures-luxations of the shoulder. Apropos of 30 cases].

Twenty-seven patients (30 shoulders) presenting with an unreduced posterior dislocation or fracture-dislocation were operated on and followed up for at least 2 years. The lesions were classified in 4 types, after Randelli: posterior dislocation with cephalic fracture inferior to 50 per cent (type I = 10 cases) or superior to 50 per cent (type II = 8 cases) and posterior fracture-dislocations with two fragments (type III = 6 cases) or several fragments (type IV = 6 cases). The first patients of the series underwent a resection of the humeral head (5 cases) or an open reduction (7 cases). During a second period 10 shoulders were reduced by a posterior approach and stabilized by transfer of the subscapularis tendon with or without the lesser tuberosity in the humeral defect 6 shoulders were reduced by an anterior approach together with derotation osteotomy. Lastly, one patient refused to be operated on and we performed a shoulder prosthesis to the last one. Necrosis of the humeral head (9 cases) appeared to be related to the severity of the lesion (type III and IV) and the type of surgical procedure (5 derotation osteotomy out of 6 and 3 open reductions out of 7) rather than to the approach route or the interval from injury to diagnosis. These results show that an anatomical repair may be attempted when the dislocation is less than 6 months old and when the impression defect involved less than 50 per cent of the articular surface. Otherwise and a fortiori in old posterior fracture-dislocations, an arthroplasty seems to be the best solution. Even if it may be clinically difficult, it offers the best chance for a functional shoulder in an active patient.

Adult↗
PubMed2003

Fracture risk following an osteoporotic fracture.

The aim of this study was to examine the pattern of fracture risk following a prior fracture at the spine, shoulder or hip. We studied 1918 patients with fractures at these sites identified from the Department of Radiology in Malmo who were followed for 5 years. Poisson regression was used to compute fracture rates immediately after the initial fracture and at 5 years thereafter in men and women aged 60 or 80 years. Immediate fracture risk was higher than that of the general population, more markedly so at the age of 60 than at 80 years. At the age of 60 years, the risk of hip, forearm and spine fractures were significantly increased following a prior spine, hip or shoulder fracture in men. A similar pattern was seen in women, except that the increase in risk of forearm fracture following a spine or hip fracture was not statistically significant. The incidence of further fractures at the shoulder, spine or hip fell with time after the first fracture, a fall that was significant for all fractures after a shoulder fracture, hip fracture after a spine fracture, and hip and spine fractures after a hip fracture. We conclude that the risk of a subsequent fracture immediately after an osteoporotic fracture is highest immediately after the event. This provides a rationale for very early intervention immediately after fractures to avoid recurrent fractures.

Age Factors↗
PubMed1987

Posterior fracture dislocation of the shoulder with biceps tendon interposition.

Posterior dislocation of the shoulder, a rare injury, results from direct trauma, indirect trauma, or via a seizure or electrical shock. We present a case with a posterior fracture dislocation of the shoulder secondary to a seizure in which interposition of the biceps tendon precluded closed reduction. The fractured lesser tuberosity fragment included the bicipital groove, allowing the biceps tendon to sublux posteriorly preventing closed reduction, thus requiring a subsequent open reduction.

Humans↗
PubMedDate not supplied

Acromion fracture associated with posterior shoulder dislocation.

We report a case involving combined acromion fracture and posterior glenohumeral dislocation. To our knowledge, this combination of injuries has not been reported previously in the literature. In our case, the shoulder dislocation was initially missed. The utility of additional radiographic views to detect this type of injury is emphasized. The mechanism of injury, course of treatment, and clinical outcome are presented.

Acromion↗