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Simultaneous Bilateral Anterior Dislocation Of The Shoulder With Fractures Of The Greater Tuberosity Following Trauma- A Case Report
Correspondence: Sanath Kumar Shetty Assistant Professor, Department of Orthopaedics, K.S. Hegde Medical Academy, Nitte University, Deralakatte, Mangalore- 575018, India. Mobile: +919845069383 E-mail: sanathkumarshetty@hotmail.com
This article was originally published by Thieme Medical and Scientific Publishers Private Ltd. and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Simultaneous bilateral shoulder dislocations are usually posterior with anterior dislocations1 being rare and simultaneous anterior shoulder dislocations with fractures of the greater tuberosity5 being even more rare usually associated with trauma or seizures2,3 . Here we present a rare case of simultaneous bilateral anterior dislocation of the shoulder with fractures of the greater tuberosity following an unusual injury mechanism which was treated surgically.
Keywords
Bilateral
anterior dislocation
shoulder
fracture
greater tuberosity
Introduction:
Simultaneous bilateral anterior shoulder dislocation with fractures of the greater tuberosity are rare and are seen in middle aged patients and may be associated with neuro -vascular injuries2. Bilateral fractures of the greater tuberosity4,5 may also result from an impaction injury also called as a shear injury.
Case report:
A 36 year old fisherman presented to our casualty 13 days after a road traffic accident with pain and restriction of movements in both the shoulders. 13 days back he was travelling in the back of a truck holding on to an overhead rod with both his hands when he was violently thrown forwards following a road traffic accident. He was taken to a local hospital where he was diagnosed to have sustained bilateral anterior shoulder dislocation. Both the dislocated shoulders were reduced and both the shoulders were immobilised in cuff and collar sling. He did not sustain head injury nor did he sustain any On examination there was swelling over both shoulders with tenderness over both greater tuberosities. There were no external injuries. Bilaterally there was gross restriction of movements with 0-400 of abduction and flexion, 0-600 of internal rotation and 0-200 of external rotation. There were no peripheral motor, sensory and vascular deficits on both sides. Radiographic examination revealed bilateral avulsion fractures of the greater tuberosities with both well reduced shoulders. Both the greater tuberosity fragments were displaced, with 6mm displacement on the right side and 8mm on the left side.
The next day both the greater tuberosity avulsion fractures were treated with open reduction and internal fixation with 4 mm cannulated cancellous screws under general anaesthesia. During surgery communition of the greater tuberosity fragments on both sides was noticed. Both the shoulders were immobilised in cuff and collar sling and he was discharged on the third day post operative. After 10 days he was reviewed, both the surgical wounds had healed and the sutures were removed. Pendulum exercises with gentle active assisted movements were started with gradual progression of the range of movements.
He was reviewed at 4th week, both the surgical wounds had healed well. Radiographs showed that both the fractures were healing. The shoulder movements were
Right side |
Left side |
|
|---|---|---|
Abduction |
0-300 |
0-300 |
Flexion |
0-400 |
0-200 |
Extension |
0-200 |
0-100 |
Internal rotation |
0-200 |
0-200 |
He was treated with active and active assisted mobilisation of both shoulders.He was reviewed again at 36 weeks post operative period. He had no complaints except for slight restriction of movements of both shoulders and he was able to carry out all his daily activities. On clinical examination the movements had improved to 0-1100 of abduction, 0-900 of flexion, 0-700 of internal rotation and 0450 of external rotation on both sides.
Radiographs showed that the fractures had healed on both the sides with slight mal union more on the left side with the screws in situ. Both the screws were removed under general anaesthesia. The sutures were removed on the ninth post operative day after both the surgical wounds had healed. He was discharged with advice to continue shoulder mobilisation exercises.
Discussion:
Simultaneous shoulder dislocations are rare entities and are usually posterior6,7 with anterior dislocation being even more rare. Those with bilateral greater tuberosity fractures are still more rare with very few cases reported. These fractures are typically communited and associated with rotator cuff tear.
- Greater tuberosities with cancellous screws in situ
- Healed fractures of the greater tuberosities
- Healing fractures of the greater tuberosities with cancellous screws in situ
- Flexion
- Internal rotation
Our patient had communition of the fragments bilaterally with displacement of the fragments; 6mm on the right side and 8mm on the left side. There was no rotator cuff tear.
There is a current trend toward operative treatment when the greater tuberosity is displaced more than 5mm or those with associated rotator cuff or labral tears. Stiffness of the shoulder may be the result of secondary adhesive capsulitis or by persistent fracture displacement. Early shoulder mobilisation is critical to successful surgical treatment.
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