Rajiv Kapila1, Bhanu Awasthi1, Manik Sehgal1, Avinash Sharma2, Preeti Kapila3. 1. Department of Orthopaedics, Dr. R.P.G.M.C, Kangra at Tanda, Himachal Pradesh, India. 2. Department of Pediatrics, Dr. R.P.G.M.C, Kangra at Tanda, Himachal Pradesh, India. 3. Department of Radiodiagnosis, Dr. R.P.G.M.C, Kangra at Tanda, Himachal Pradesh, India.
Abstract
INTRODUCTION: Combination of Anterior Glenohumeral Dislocation with Ipsilateral Shaft humerus fracture is an rare co-occurrence and guidelines of its management are lacking. It is a rare opportunity for orthopaedic surgeon to observe simultaneous shoulder dislocation with ipsilateral humeral shaft fracture. There has been a total of around twenty cases reported since 1940. CASE PRESENTATION: A case of elderly female with medical co-morbidities who sustained this injury while working in wheat farms. She presented with complaints of pain and swelling in right arm with inability to move right arm. She was diagnosed as a case of ipsilateral fracture of proximal humerus with anterior glenohumeral dislocation. She was successfully treated with open reduction and internal fixation (ORIF) for fracture shaft humerus with long proximal humerus locking plate, because of proximal extension of long oblique fracture line using standard delto-pectoral approach with anterolateral distal extension of surgical approach after visualising radial nerve. Following fixation of shaft, close reduction was carried out for anterior shoulder dislocation under image intensifier. Patient was put on regular physiotherapy and follow up at 4 weekly interval for a period of 3 months and subsequently bimonthly interval upto 1 year. Patient achieved near normal and pain- free range of motion at 1 year. CONCLUSION: Anterior Glenohumeral Dislocation with Ipsilateral Shaft humerus fracture, can be easily missed clinically in obese patients. Close reduction is possible after attaining adequate lever arm by fixing shaft followed by attempt to reduce dislocation. Meticulous surgical technique coupled with dedicated and supervised physiotherapy is essential to bring out good functional outcome.
INTRODUCTION: Combination of Anterior Glenohumeral Dislocation with Ipsilateral Shaft humerus fracture is an rare co-occurrence and guidelines of its management are lacking. It is a rare opportunity for orthopaedic surgeon to observe simultaneous shoulder dislocation with ipsilateral humeral shaft fracture. There has been a total of around twenty cases reported since 1940. CASE PRESENTATION: A case of elderly female with medical co-morbidities who sustained this injury while working in wheat farms. She presented with complaints of pain and swelling in right arm with inability to move right arm. She was diagnosed as a case of ipsilateral fracture of proximal humerus with anterior glenohumeral dislocation. She was successfully treated with open reduction and internal fixation (ORIF) for fracture shaft humerus with long proximal humerus locking plate, because of proximal extension of long oblique fracture line using standard delto-pectoral approach with anterolateral distal extension of surgical approach after visualising radial nerve. Following fixation of shaft, close reduction was carried out for anterior shoulder dislocation under image intensifier. Patient was put on regular physiotherapy and follow up at 4 weekly interval for a period of 3 months and subsequently bimonthly interval upto 1 year. Patient achieved near normal and pain- free range of motion at 1 year. CONCLUSION: Anterior Glenohumeral Dislocation with Ipsilateral Shaft humerus fracture, can be easily missed clinically in obese patients. Close reduction is possible after attaining adequate lever arm by fixing shaft followed by attempt to reduce dislocation. Meticulous surgical technique coupled with dedicated and supervised physiotherapy is essential to bring out good functional outcome.