Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2019; 7(7): 849-854
Published online Apr 6, 2019. doi: 10.12998/wjcc.v7.i7.849
Open anterior glenohumeral dislocation with associated supraspinatus avulsion: A case report
Cosmin Ioan Faur, Bogdan Anglitoiu, Ana-Maria Ungureanu
Cosmin Ioan Faur, Bogdan Anglitoiu, 2nd Department of Orthopaedics and Traumatology, University of Medicine and Pharmacy “Victor Babes”, Timiș, Timișoara 300736, Romania
Ana-Maria Ungureanu, Department of Radiology and Medical Imaging, University of Medicine and Pharmacy “Victor Babes”, Timis, Timișoara 300736, Romania
Author contributions: The author contributed equally to this work.
Informed consent statement: Informed consent to publish was obtained from the patient.
Conflict-of-interest statement: All authors declare no conflict of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Cosmin Ioan Faur, MD, PhD, Assistant Professor, Department of Orthopedics and Traumatology, University of Medicine and Pharmacy "Victor Babes" Timisoara, Bd. Bulbuca Iosif, No.10, Timis, Timisoara 300736, Romania. faur17@gmail.com
Telephone: +40-72-3962104
Received: November 14, 2018
Peer-review started: November 14, 2018
First decision: December 22, 2019
Revised: February 24, 2019
Accepted: March 8, 2019
Article in press: March 9, 2019
Published online: April 6, 2019
Abstract
BACKGROUND

Open dislocation of the glenohumeral joint is a very rare complication with only six cases described in the literature. Most cases resulted in severe complications like avascular necrosis of the humeral head or septic arthritis with poor functional results. The “mandatory” treatment of choice is surgery, with accurate debridement and reconstruction of the damaged soft tissues. However, the results in these cases do not approach those seen in classical dislocations.

CASE SUMMARY

This case report is the first description of an anterior open glenohumeral dislocation without associated fractures, but with complete avulsion of the soft tissue envelope of the proximal humerus. Surgical treatment consisted of copious lavage with saline solution, meticulous debridement of the nonviable soft tissues, reduction of the dislocated humeral head and reconstruction of the soft tissue envelope of the humeral head. The selected surgical approach was an inferior extension of the wound at the level of the delto-pectoral groove, as the best choice to be able to perform an adequate debridement and capsulo-tendinous reinsertion. At 6 mo there were no clinical signs of instability of the glenohumeral joint, the functionality of the joint was restricted to 90º of anterior elevation, internal rotation to L2, with severe limitation of abduction (60º) and external rotation (0º) but without residual pain, with an Oxford shoulder Score of 28.

CONCLUSION

Thorough reconstruction of the soft tissues surrounding the shoulder joint and an early rehabilitation program are key points to a good functional result.

Keywords: Open shoulder dislocation, Case report, Functional impairment, Surgical treatment, Avascular necrosis

Core tip: Open dislocation of the scapulo-humeral joint is a very rare finding in the emergency department and is usually the result of a high velocity trauma. The “mandatory” treatment of choice is surgery, with accurate debridement and reconstruction of the damaged soft tissues. However, the results in these cases do not approach those seen in classical dislocations.