Greater tuberosity fractures are less common and are seen in cases of shoulder dislocations and in those with osteoporosis.
A 'ball' at the top of the upper arm bone (the humerus) fits neatly into a 'socket', called the glenoid, which is part of the shoulder blade (scapula).Ī fracture is a break in the bone that commonly occurs as a result of injury, such as a fall or a direct blow to the shoulder. The shoulder joint is a ball and socket joint. All rights reserved.Home » Shoulder » Shoulder (Proximal Humeral) Fractures Shoulder (Proximal Humeral) Fractures
Proximal humerus closed reduction dislocation emergency department fracture sedation.Ĭopyright © 2021 Journal of Shoulder and Elbow Surgery Board of Trustees. Finally, these data confirm prior reports that closed reduction of simple shoulder dislocations in patients aged >65 years is safe in the ED. For displaced neck fractures, closed reduction can be successful in select patients. ED reduction was attempted in 25 of the 50 displaced humeral neck fracture-dislocations and was successful in 10 of these (40%).įor patients with greater tuberosity fracture-dislocations, there is a low rate of displacement with a reduction attempt in the ED, but an ED reduction attempt in nondisplaced neck fractures is not recommended because of the high rate of displacement. 1 of 4 patients who underwent the initial reduction attempt in the operating room. Displacement occurred in 6 of 8 patients with nondisplaced neck fractures who underwent an initial ED reduction attempt vs. Of the 103 patients with greater tuberosity fracture-dislocations, only 1 had displacement of a humeral shaft fracture during ED reduction. None of the patients with simple dislocations had displacement during an ED reduction attempt, including 100 patients aged >65 years. Of the patients with fracture-dislocations, 103 had greater tuberosity fractures, 12 had nondisplaced surgical neck fractures, and 50 had displaced surgical neck fractures. We identified 165 patients with fracture-dislocations and 484 patients with simple dislocations during the same period. Imaging and medical records were reviewed to evaluate whether the reduction attempt was successful, unsuccessful without worsening, or unsuccessful with worsening alignment of any fractures, as well as the ultimate clinical outcome. This was a retrospective case review of adult patients with shoulder dislocations and fracture-dislocations seen in the ED at a level 1 trauma center over a 10-year period. There is limited guidance in the literature about the risks of an initial reduction attempt in the ED as a function of fracture pattern to help guide physicians with this decision. The alternative, a closed reduction attempt in the operating room, has the benefit of full paralysis but requires additional resource utilization. Shoulder fracture-dislocations can represent a challenging management scenario in the emergency department (ED) because of concern for the presence of occult fractures that may displace during a reduction attempt.