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International Orthopaedics

, Volume 43, Issue 5, pp 1215–1222 | Cite as

Size of greater tuberosity fragment: a risk of iatrogenic injury during shoulder dislocation reduction

  • Junfei Guo
  • Yueju Liu
  • Lin Jin
  • Yingchao Yin
  • Zhiyong HouEmail author
  • Yingze Zhang
Original Paper

Abstract

Purpose

Shoulder dislocation with greater tuberosity fractures (GTF) is becoming increasingly common, as is the number of cases of iatrogenic humeral neck fractures (IHNF) during reduction. This study investigated the relationship between size of greater tuberosity fragment and occurrence of IHNF in patients with shoulder dislocation and GTF.

Methods

A retrospective study was made to identify all patients presenting with shoulder dislocation with GTF between September 2014 and July 2016. There were 74 patients with an average age of 52.4 years (range 18–84 years) representing 76 cases of shoulder dislocation associated with GTF. Patient age, injury mechanism and location, treatment waiting time, and reduction method were noted. Using conventional anterior-posterior view radiographs, three points were identified as A, B, and C. Distance ratios between AC and AB were calculated, then the resulting ratio was compared to a critical value of 0.4.

Results

More iatrogenic fractures occurred in cases where the AC/AB ratio exceeded 0.4. Most (13) occurred during emergency Hippocratic manual reduction. Only five of 18 iatrogenic fractures (27.78%) occurred during surgery while under traction. Women ran a higher risk of iatrogenic fracture than men (female/male ratio 8:1). On average, women were older than men at the time of fracture (59.75 years for women vs. 42 years for men).

Conclusions

A statistically significant relationship exists between size of greater tuberosity fragment and occurrence of iatrogenic humeral neck fractures during the reduction of shoulder dislocation. The larger the greater tuberosity fragment, the higher the incidence of iatrogenic humeral neck fractures. For such fracture dislocations, we recommend open reduction with internal fixation directly and using a Kirschner wire in advance to reinforce the proximal humerus before reduction of the shoulder.

Keywords

Shoulder dislocation Size of greater tuberosity fragment Reduction Iatrogenic neck fracture Retrospective study 

Abbreviations

GTF

greater tuberosity fractures

LTF

less tuberosity fracture

IHNF

iatrogenic humeral neck fractures

ORIF

open reduction with internal fixation

OTA

Orthopaedic Trauma Association

ROC curve

receiver operating characteristic curve

Notes

Acknowledgements

Proofreading and revision services were provided by a professional editor.

Author contributions statement

Junfei Guo and Zhiyong Hou designed the study. Junfei Guo and Lin Jin collected the data of the study. Junfei Guo drafted the manuscript. Yingchao Yin, Yueju Liu, Zhiyong Hou, and Yingze Zhang revised the manuscript before submission. All authors read and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was approved by the institutional internal review board of the participating institution.

Informed consent

For this type of study, formal consent is not required.

References

  1. 1.
    Robinson CM, Shur N, Sharpe T et al (2012) Injuries associated with traumatic anterior glenohumeral dislocations. J Bone Joint Surg Am 94:18–26CrossRefGoogle Scholar
  2. 2.
    Ferkel RD, Hedley AK, Eckardt JJ (1984) Anterior fracture-dislocations of the shoulder: pitfalls in treatment. J Trauma 24:363–367CrossRefGoogle Scholar
  3. 3.
    Dimakopoulos P, Panagopoulos A, Kasimatis G et al (2007) Anterior traumatic shoulder dislocation associated with displaced greater tuberosity fracture: the necessity of operative treatment. J Orthop Trauma 21:104–112CrossRefGoogle Scholar
  4. 4.
    Han RJ, Sing DC, Feeley BT et al (2016) Proximal humerus fragility fractures: recent trends in nonoperative and operative treatment in the Medicare population. J Shoulder Elb Surg 25:256–261CrossRefGoogle Scholar
  5. 5.
    Green A, IzziJ JR (2003) Isolated fractures of the greater tuberosity of the proximal humerus. J Shoulder Elb Surg 12:641–649CrossRefGoogle Scholar
  6. 6.
    Platzer P, Kutscha-Lissberg F, Lehr S et al (2005) The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity. Injury 36:1185–1189CrossRefGoogle Scholar
  7. 7.
    Kim KC, Rhee KJ, Shin HD et al (2008) Arthroscopic fixation for displaced greater tuberosity fracture using the suture-bridge technique. Arthroscopy 24(120):e1–e3Google Scholar
  8. 8.
    Matti Z, Unnithan A, Hong T (2012) Isolated greater tuberosity fractures: comparison of outcomes. J Bone Joint Surg Br 94-B(suppl XLI):9Google Scholar
  9. 9.
    Hersche O, Gerber C (1994) Iatrogenic displacement of fracture-dislocations of the shoulder. A report Seven Cases J Bone Joint Surg Br 76:30–33CrossRefGoogle Scholar
  10. 10.
    Atoun E, Narvani A, Even T et al (2013) Management of first-time dislocations of the shoulder in patients older than 40 years: the prevalence of iatrogenic fracture. J Orthop Trauma 27:190–193CrossRefGoogle Scholar
  11. 11.
    Chu X, Liu F, Tong P (2014) Iatrogenic fractures of proximal humerus caused by manual reduction applied to anterior shoulder dislocation with massive fracture of the greater tuberosity. J Clinical Orthopaedics 17:105Google Scholar
  12. 12.
    Ceroni D, Sadri H, Leuenberger A (2000) Radiographic evaluation of anterior dislocation of the shoulder. Acta Radiol 41:658–661CrossRefGoogle Scholar
  13. 13.
    Ranawat AS, DiFelice GS, Suk M et al (2007) Iatrogenic propagation of anterior fracture-dislocations of the proximal humerus: case series and literature review with suggested guidelines for treatment and prevention. Am J Orthop (Belle Mead NJ) 36:e133–e137Google Scholar
  14. 14.
    Demirhan M, Akpinar S, Atalar AC et al (1998) Primary replacement of the humeral head in iatrogenically displaced fracture-dislocations of the shoulder: a report about six cases. Injury 29:525–528CrossRefGoogle Scholar
  15. 15.
    Wronka KS, Ved A, Mohanty K (2017) When is it safe to reduce fracture dislocation of shoulder under sedation? Proposed treatment algorithm. Eur J Orthop Surg Traumatol 27:335–340CrossRefGoogle Scholar
  16. 16.
    Koda M, Hisamitsu J, Nakayama S et al (2014) Successful closed reduction for iatrogenic displacement of the anatomical neck of the humerus: a case report. BMC Res Notes 7:770CrossRefGoogle Scholar
  17. 17.
    Castagno AA, Shuman WP, Kilcoyne RF et al (1987) Complex fractures of the proximal humerus: role of CT in treatment. Radiology 165:759–762CrossRefGoogle Scholar
  18. 18.
    Ahmad R, Ahmed S, Bould M (2007) Iatrogenic fracture of humerus—complication of a diagnostic error in a shoulder dislocation: a case report. J Med Case Rep 1(41)Google Scholar
  19. 19.
    Kahn JH, Mehta SD (2007) The role of post-reduction radiographs after shoulder dislocation. J Emerg Med 33:169–173CrossRefGoogle Scholar
  20. 20.
    Razemon JP, Baux S (1969) Fractures and fracture-dislocations of the upper extremity of the humerus. Rev Chir Orthop Reparatrice Appar Mot 55:387–496Google Scholar
  21. 21.
    Lind T, Kroner K, Jensen J (1989) The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg 108:285–287CrossRefGoogle Scholar
  22. 22.
    Lee SH, Dargent-Molina P, Bréart G, EPIDOS Group (2002) Epidemiologie de l’Osteoporose Study. Risk factors for fractures of the proximal humerus: results from the EPIDOS prospective study. J Bone Miner Res 17:817–825CrossRefGoogle Scholar
  23. 23.
    Mutch J, Laflamme GY, Hagemeister N et al (2014) A new morphological classification for greater tuberosity fractures of the proximal humerus. Bone Joint J 96-B:646–651CrossRefGoogle Scholar
  24. 24.
    Henderson RS (1952) Fracture-dislocation of the shoulder with interposition of long head of biceps. J Bone Joint Surg Br 34-B:240–241CrossRefGoogle Scholar
  25. 25.
    Aufranc OE, Jones WN, Turner RH (1966) Comminuted fracture dislocation of the proximal humerus. JAMA 195:770–773CrossRefGoogle Scholar

Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgeryThird Hospital of Hebei Medical UniversityShijiazhuangChina

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