Talk
I can see a dislocated right shoulder with greater tuberosity fracture and the shoulder is kept abducted. This suggests anterior dislocation. I would like to see the velpeau/axillary view to confirm this. I will also ensure that the injury is closed, isolated and the limb is neurovasculary intact.
I will attempt a gentle closed relocation of the shoulder under sedation, keeping in mind that presence of a fracture can make this attempt difficult and complicate the injury by causing further fractures proximally.
If this attempt fails, I will arrange for an emergency table first in the morning trauma list. I will inform my consultant as this may require open reduction.
If the shoulder could be closely reduced, I will immobile the limb in shoulder immobiliser. Post reduction I will check for stability and NV status and arrange for a CT. I that shows displacement of GT/ other fracture, I will offer open reduction and internal fixation
I can see AP view of right shoulder with shoulder seems kept adducted. There is reduced overlap between head and the glenoid and head appears like a light bulb. I suspect posterior dislocation of shoulder and would like to see a velpeau/axillary view.
The axillary view confirms that there is posterior dislocation and there is also engaging Hill Sachs lesion. I will ensure that the injury is isolated closed and limb is neurovascularly intact.
I anticipate that the relocation under sedation will be difficult and will arrange for a closed reduction under anaesthesia. I will inform my consultant, in case opening become necessary. Post reduction I will check for stability and NV status
I will take a CT post reduction. I will immobile the shoulder for 3 weeks and start RC and peri scapular strengthening. If the shoulder is deemed unstable, I will take MRI arthrogram to look for labral pathology. If there is posterior banker lesion, the principle is to perform an open or arthroscopic repair and posterior capsular shift.
For Hill Sachs lesion
- <25%: Remplisage
- 25-50%: Subscapularis transfer
50%: LT transfer, Modified Mclaughlin procedure