The management of bilateral posterior fracture dislocations of the shoulder: a case series illustrating management options

Abstract

Background: Although dislocation of the shoulder is a relatively common event, the overwhelming majority of injuries are anterior. Posterior shoulder dislocation is more uncommon, comprising between 3% and 5% of all shoulder dislocations. One percent of shoulder dislocations involve a fracture, whereas only 0.9% of the 1500 cases reported by Neer (J Bone Joint Surg Am 1970; 52:1077-89; J Bone Joint Surg Am 1970; 52:1090-103) concerned posterior fracture dislocations. Bilateral posterior fracture dislocation is an even rarer event, comprising just 5% of all posterior fracture dislocations. Given the rarity and relative poor outcome often observed after these severe injuries, it is important that upper limb function is optimized. Methods: Bilateral posterior fracture dislocations of the shoulder pose a difficult clinical challenge that requires careful management planning. To date, there have been three isolated case reports of using contralateral osteochondral humeral autograft and hemiarthroplasty. We report our experiences and clinical outcomes in managing four such cases using a variety and combination of treatments, including the first reported use of reverse shoulder arthroplasty with contralateral osteochondral humeral autografting. Results: Shoulders reconstructed with humeral autograft demonstrated superior Oxford Shoulder Scores and an improved range of motion, as measured by a markerless machine vision system, compared to hemiarthroplasty. Conclusions: Our results support the use of a contralateral humeral autograft in bilateral posterior shoulder fracture dislocation.

Near-simultaneous bilateral reverse total shoulder arthroplasty for the treatment of bilateral fracture dislocations of the shoulder

“…At the time, there is only one instance where a rTSA was used in conjunction with an osteochondral autograft for treatment of bilateral posterior fracture dislocations 9. This patient achieved a satisfactory outcome with the only limitation being loss of external rotation.…”

“…When ORIF is attempted in these elderly patients, there is an increased risk of avascular necrosis and patient’s will likely need to undergo subsequent surgeries 5 6. Another treatment option illustrated in the literature for patients with bilateral posterior dislocated proximal humerus fractures involves osteochondral autograft and fixation of one side of the one shoulder and hemiarthroplasty for the contralateral side 7–9. In most instances, improved function and range of motion is seen in the extremity that undergoes reconstruction with humeral autograft versus the side that undergoes hemiarthroplasty.…”

Bilateral neglected posterior dislocation of the shoulder treated by reverse arthroplasty and contralateral osteochondral autograft. A case report

“…All the studies published in literature on bilateral PSD are case reports or small case series. We could find only five cases of shoulder replacement combined with contralateral osteochondral humeral autograft [ [8] , [9] , [10] , [11] ]: four patients were treated with hemiarthroplasty and only one patient with a reverse prosthesis. All these patients were male and suffered epileptic seizures, so this is the first report of this procedure for a chronic bilateral PSD due to trauma.…”

Simultaneous bilateral reverse shoulder arthroplasty for bilateral four-part fracture of the proximal humerus in an elderly patient: A case report

“…To our opinion, treatment of simultaneous bilateral proximal humeral fracture should rely on the same principles as for monolateral injury, even if concerns about post-operative care and rehabilitation course exist, especially in case of arthroplasty. To date, while bilateral HA have already been described [[19], [20], [21]], we were not able to find in the literature any report of simultaneous bilateral RSA for the management of a bilateral four-part proximal humeral fracture.…”

“…An increasing number of Authors suggest reverse shoulder arthroplasty (RSA) as a valid option instead of hemiarthroplasty (HA) or open reduction and internal fixation (ORIF) for the treatment of displaced fractures of humeral head in this population [[10], [11], [12], [13]], and a multicenter combined randomized controlled and observational trial on this issue has started [14]. In the rare situation of simultaneous bilateral proximal humeral fracture, choice of treatment is still more controversial, and it can vary from conservative management [15] to closed reduction and percutaneous fixation [16] to ORIF of one or both sides [17], to HA of one side associated to conservative treatment [18] or ORIF [5,18] or osteochondral autograft [19] of the contralateral side, to even bilateral HA [20,21].…”