Bilateral combined fracture of the greater tuberosity with anterior internal shoulder dislocation

Abstract

Introduction and importance: Bilateral combined fractures of the greater tuberosity with anterior internal shoulder dislocation are extremely rare, presenting challenges in treatment due to their uncommon occurrence and lack of standardized management protocols.

Case presentation: We report the case of a 22-year-old patient who experienced bilateral anterior shoulder dislocations with associated fractures of the greater tuberosities following a seizure-induced fall. Clinical Discussion: The unique aspect of our case is the unusual mechanism of injury. Unlike typical convulsive seizures, which often result in bilateral posterior dislocations, our patient suffered bilateral anterior dislocations and fractures of the greater tuberosities. Therapeutic management of greater tuberosity fractures lacks a standardized approach, but surgical intervention is warranted if displacement exceeds 0.5 cm. Treatment options include open reduction and internal fixation (ORIF), percutaneous screw fixation, arthroscopic procedures with suture anchors for double-row repair, or a combination of arthroscopic techniques and screw fixation. ORIF with plate osteosynthesis may be recommended for comminuted fractures with large fragments. To assess functional outcomes, commonly used scoring systems include the UCLA Shoulder Score, ASES Score, and Constant-Murley Score.

Conclusion: Bilateral anterior shoulder dislocation associated with combined fractures of the greater tuberosity is an extremely rare occurrence. Given its anatomopathological significance and impact on functional recovery, careful and individualized management of greater tuberosity fractures is crucial, considering its role as a point of insertion for the rotator cuff tendons.

Keywords: Anterior dislocation; Case report; Fracture; Greater tuberosity; Screw; Shoulder.

Fig. 1

Bilateral antero internal shoulder dislocations associated with bilateral fractures of the greater tuberosities.

Fig. 2

Reduction of the dislocations with persistent inferior displacement of the greater tuberosities.

Fig. 3

Bilateral shoulder CT scan.

Fig. 4

X-rays at 30 months follow up.

Fig. 5

Forward flexion.

Fig. 6

Backward extension.

Fig. 7

External rotation.

Fig. 8

Internal rotation.