A Case of Neglected Posterior Fracture Dislocation of the Shoulder Treated With Greater Tuberosity Osteotomy

Abstract

Posterior dislocation of the shoulder joint is a rare condition. It is often misdiagnosed owing to a lack of evident clinical features compared with anterior shoulder dislocation, and inappropriate radiological examination. We present a case of chronic posterior fracture dislocation treated with greater tuberosity osteotomy. A 66-year-old man was injured in a fall while carrying a drone. He was referred to our hospital following 3 months of conservative treatment at a nearby clinic, without reduction of the posterior dislocation. Physical examination revealed a prominent reduction in shoulder joint range of motion and shoulder pain. Radiological examination revealed posterior shoulder dislocation associated with greater tuberosity malunion and a small bone fracture of the posterior portion of the glenoid. Open reduction and internal fixation, including greater tuberosity osteotomy, were performed. Although subluxation of the posterior dislocation persisted postoperatively, the humeral head gradually returned to its centric shoulder joint position owing to rotator cuff force coupling. At 24-month follow-up, the patient showed excellent shoulder results.

Figure 1

Initial plain radiographic images on first referral to our hospital. (a) An anteroposterior radiograph showing a light bulb-like appearance of the humeral head with a malunited greater tuberosity. (b) A scapular Y view showing the posterior shift of the humeral head.

Figure 2

Preoperative CT. (a) Axial and (b) sagittal views showing posterior shoulder dislocation with a malunited greater tuberosity and a small glenoid fracture of the posterior portion. (c, d) 3D reconstruction of the CT images. (d) The humerus was removed to observe the glenoid. Asterisk: greater tuberosity; white arrowhead: glenoid fracture. CT: computed tomography; 3D: three dimensional.

Figure 3

Preoperative MRI. (a) A coronal view showing an intact rotator cuff supraspinatus tendon. (b) The axial view showing an intact rotator cuff and subscapularis and infraspinatus tendons and no dislocation of the long head of the bicep tendon. Asterisk: greater tuberosity; white arrowhead: intact rotator cuff. MRI: magnetic resonance imaging.

Figure 4

Intraoperative view. (a) A malunited greater tuberosity was observed using the deltopectoral approach. The greater tuberosity protrudes just lateral to the intertubercular groove. (b) Following a release of the groove, the long head of the bicep tendon was observed. A malunited greater tuberosity is easily recognizable. Asterisk: greater tuberosity; white arrowhead: long head of bicep tendon.

Figure 5

Plain radiographic images on postoperative Day 1. (a) AP view, (b) Y view.

Figure 6

Postoperative CT and MRI examinations. (a) CT on postoperative Day 1. (b) MRI 3 months postoperatively. (c) CT images taken 12 months postoperatively. The centric position of the humeral head showing gradual improvement. CT: computed tomography; MRI: magnetic resonance imaging.

Figure 7

Plain postoperative radiographic images. Plain postoperative radiographic images taken at 24 months postoperatively. (a) AP view, (b) Y view.

Figure 8

Final follow-up at 24 months postoperatively. (a, b) Active elevation. (c) Active external rotation. (d) Active internal rotation.