MANUAL MINORS
A shoulder fracture-dislocation is a severe injury where both a fracture of the bones forming the shoulder joint (typically the humeral head) and a dislocation, where the humeral head is displaced from the glenoid cavity of the scapula, occur simultaneously. This injury is caused by high-energy trauma, such as falls, car accidents, or sports injuries, and is common in older adults with weakened bones.
Diagnosis
The diagnosis is suspected based on a history of significant trauma, accompanied by intense pain, visible shoulder deformity, inability to move the arm, and possibly a “dropped shoulder” appearance.
Anteroposterior, lateral, and axillary X-rays of the shoulder confirm both the fracture and the dislocation, helping determine the direction of the dislocation (anterior, posterior, or inferior) and the type of fracture. In complex cases, a computed tomography (CT) scan is useful for assessing bone damage and planning surgical treatment.
Differential Diagnosis
Pathology | Characteristics |
|---|---|
Anterior shoulder dislocation | Visible deformity, without fracture, anterior displacement of the humerus |
Surgical neck fracture of the humerus | Fracture of the neck without displacement of the humeral head from the glenoid cavity |
Rotator cuff tear | Weakness and shoulder pain without visible deformity |
Clavicle fracture | Pain and deformity in the clavicle, without shoulder dislocation |
Bankart lesion | Dislocation with labrum tear, without humeral head fracture |
Emergency Management
Immediate emergency management includes pain relief with analgesics and anti-inflammatory drugs, and stabilisation of the arm with a splint or sling. Closed reduction of the dislocation is performed under sedation or anaesthesia.
It is crucial to assess the neurovascular integrity of the arm (axillary nerve, axillary artery) before and after the reduction, as vascular or nerve compromise may occur. If the dislocation cannot be reduced through closed means or there are displaced fractures, urgent surgical intervention is required.
Definitive Treatment
Definitive treatment depends on the type and severity of the fracture-dislocation. In cases of non-displaced fractures with a reduced dislocation, conservative management with immobilisation for 4 to 6 weeks is appropriate, followed by physiotherapy to restore mobility.
Displaced or comminuted fractures require surgery, which may include open reduction and internal fixation with plates or screws, or even shoulder arthroplasty (partial or total replacement) in severe fractures, especially in older adults. Postoperative rehabilitation is essential to restore shoulder function and prevent complications such as stiffness or arthritis.
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