Use of a Reverse Shoulder Arthroplasty Following a Fracture-Dislocation with a Brachial Plexus Palsy: A Case Report

Abstract

Case: An 80-year-old woman sustained a fracture-dislocation of the proximal aspect of the humerus with a near-complete brachial plexopathy, which was successfully managed acutely using a reverse shoulder arthroplasty (RSA) with repair of the greater and lesser tuberosities. The palsy, which was confirmed with nerve conduction studies, recovered uneventfully along with functional improvement of the shoulder. At the most recent follow-up, there was complete resolution of the plexopathy, with excellent, pain-free range of motion.

Conclusion: Acute RSA with tuberosity repair may be a reasonable treatment modality in the setting of an acute brachial plexus palsy following a comminuted fracture-dislocation of the proximal aspect of the humerus in an elderly patient.

Fig. 1

Preoperative anteroposterior radiograph demonstrating a valgus-impacted fracture-dislocation of the proximal aspect of the humerus with comminution and displacement of the greater tuberosity fragment.

Fig. 2

Anteroposterior postoperative radiographs of the right shoulder taken at the 10-day (Fig. 2-A), 6-month (Fig. 2-B), and 12-month (Fig. 2-C) follow-up, documenting anatomic healing of the greater tuberosity.

Fig. 3

Anteroposterior radiograph of a patient treated with an RSA and tuberosity excision in the setting of an unappreciated axillary nerve palsy. The prosthesis remained unstable despite 2 revision attempts.