Unreduced Chronic Dislocation of the Humeral Head With Ipsilateral Humeral Shaft Fracture

Abstract

The purpose of reporting this case is to illustrate a treatment plan for a chronically anteriorly dislocated shoulder associated with an ipsilateral humerus fracture, a condition heretofore not addressed in the literature to our knowledge. An 18-year-old female, left hand dominant, injured her left upper extremity and liver in a motor vehicle accident. X-rays at time of injury revealed a diaphyseal facture of her left humerus. No x-rays of the shoulder were taken at time of injury. Treatment consisted of a plaster cast application and discharge at 1 week. The patient was seen again 4 weeks postinjury, at which time only humerus films were taken and the immobilization was continued. At 45 days postinjury, the patient complained of left shoulder pain, and shoulder x-rays at that time revealed an anterior subcoracoid dislocation of the left humeral head. At surgery 52 days postinjury, the humeral shaft fracture was found to be unstable and external fixation of both the fracture (2 pins above and below the fracture) and the reduced but still unstable humeral head was performed (a pin through the humeral head into the glenoid). The external fixator was removed at 3 weeks, and at a 3-year follow-up, the patient had acquired nearly full range of motion of her shoulder without pain and no significant limitations of her arm movements or activities. In conclusion, given a patient with a chronic anteriorly dislocated shoulder and a healing ipsilateral shaft fracture, an external fixation stabilization of both the fracture and the relocated repaired dislocation is a viable treatment option.

Chronic Irreducible Anterior Dislocation of the Shoulder without Significant Functional Deficit

“… 1 3 4) However, though it is uncommon among chronic dislocations, there have been a few cases where this ailing condition did not incite persistent pain, creating a further postponement in establishing the diagnosis. 4 5) In the case described in this paper, chronic shoulder dislocation was found in a patient after 1 year, with the affected individual experiencing little pain. This patient had not received medical treatment due to an improvement in symptoms and function shortly after an injury.…”

“…These methods include no treatment, closed manipulation, open reduction with or without fixation and resection arthroplasty, and recent additions of arthroscopic reduction with repair of associated labral and rotator cuff injuries, and joint replacement. 1 3 5 7 8) Although reduction is relatively easy in most cases of acute shoulder dislocation, it will become nearly impossible in chronic cases to reduce a joint that has been dislocated for more than 2 weeks. One study suggested that attempts to reduce the joint should be dropped if the dislocation has been left for more than 6 weeks.…”

“…This is a temporary application to prevent redislocation until the soft tissues heal. Although it has been reported to be effective, 5 6 8) the method causes injury to the articular surfaces of the humeral head and glenoid. In addition, fixating the articulation may prevent the possible beneficial effects of early shoulder motion, which improves articular cartilage nutrition.…”

“…Although this varies according among the literature, chronic dislocation is defined as a case in which the diagnosis was missed for several days to weeks after initial dislocation. 3 4 5 6 7) They are usually difficult to reduce in the conventional manner, often requiring a surgical procedure in order to reduce and stabilize the joint, and a delay in making the diagnosis and treating the condition generally leads to significant functional and structural deterioration in the patient. Chronic dislocation is mostly seen in elderly and mentally disabled patients, and missing the diagnosis initially in young age groups is also possible when a person has multiple traumas.…”

Missed posterior dislocation of the shoulder after intramedullary fixation of humeral fractures: A report of three cases

“…8,10,12 To date, no reports have been published of missed posterior dislocation after intramedullary fixation of proximal humeral fractures. Cooper 2 stated in 1839 that the physical findings were so classic that it was ''an accident which cannot be mistaken.''…”