Emergency Cases Northwest Group

040 Shoulder Shenanigans

Situation

Fracture dislocation of shoulder was unstable; no reduction in ED

Background

An elderly lady fell and suffered a fracture dislocation of the shoulder. The dislocation was anterior. There were 2 fractures: the greater tubercle [or tuberosity] and the humeral neck. Referred to orthopaedics for reduction in theatre.

Assessment

The neck of humerus fracture made it unsuitable for reduction in ED; the risk is attempt at reduction would displace the fracture and make it worse.

The X-ray was similar to this [inferior dislocation in this case]:

Case courtesy of Dr Nikola Todorovic, Radiopaedia.org, rID: 52616

Recommendation

If there is a fracture dislocation of the shoulder involving just the greater tubercle, reduction in the ED can be attempted.

But if the fracture involves the neck of the humerus, don’t reduce in the ED: refer to orthopaedics.

PLEASE DO NOT INCLUDE ANY PATIENT IDENTIFIABLE DATA OR GEO-LOCATION DATA IN THE SUBMISSION OR IN ANY ATTACHED IMAGES

Emergency Cases Northwest Group