Complex shoulder

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Complex shoulder

Отправлено Harpreet S. Gill 07 Май 2007, 00:13
Dear all, A heavy built 30-year-old male patient sustained fracture dislocation of left shoulder about 8 months back.

For this ORIF with K-wires was done elsewhere. K-wires were removed at 6 weeks and patient advised physiotherapy. He has been doing physio dedicatedly since then.
He has 60* elevation…primarily it is scapulothoracic motion. External rotation at side is minus 30*.
Movements are painful.
Looking at his previous x-rays, I was thinking of refixing the greater tuberosity, however got anaxillary view done today which was never done during this period and this shows non-union.
He can’t be left as such as he wants movement to tie his turban.
Kindly advise about further management.
Thanks
Dr. Harpreet S. Gill
Consultant Orthopaedics
SPS Apollo Hospitals
Ludhiana

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Re: Complex shoulder
George Thomas 07 Май 2007, 00:24

It looks like the initial injury was a head splitting fracture. Presently the patient has a non-union at the level of the anatomical neck with displaced tuberosities. I would tackle the non-union, and would try to replace the tuberosities, a difficult procedure. I would use the proximal humerus locking plate from the AO.
However, even if all goes well ( a big if!), the prognosis for regaining movement sufficient to tie his turban is poor.

Sincerely,
George Thomas,
Railway Hospital,
Chennai, India.

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