Sunday, August 13, 2017

Proximal humerus fracture dislocation - Do we need to address the instability acutely?

This is a middle aged patient with a proximal humerus fracture dislocation. On the axillary view it is demonstrated that the humeral head is locked in a anteriorly dislocated position. The anterior inferior rim of the glenoid created the Hill Sachs lesion. The impaction was significant as the greater tuberosity is separated from the head and displaced and half of the glenoid is impacted in the humerus. Those injuries do have sometimes an associated soft tissue or bony Bankart lesion. Most of the time it is not necessary to address the instability at the time of fixation of the fracture, there is no need for repair of the soft tissues and no need for ORIF of the small glenoid fracture when it is present.

The stiffness that develops due to the proximal humerus fracture limits the ROM of the shoulder and for that reason the shoulder remains stable. Close follow up after surgery is recommended as such fractures can become unstable in the acute postoperative period.