Open inferior Glenohumeral fracture dislocation with interposition of the Subscapularis and greater tuberosity

Abstract

Open dislocations of the shoulder are extremely rare. Emergency stabilisation of the trauma patient, prompt joint reduction, and careful exploration of neurovascular structures are fundamental management principles. The report describes the case of a young male cyclist who suffered an open inferior Glenohumeral fracture dislocation. Urgent stabilisation of the patient was necessary prior to reduction of the fracture dislocation. Significant bleeding was observed from an axilla wound, the humeral head was found protruding through the skin. Emergency imaging revealed the integrity of the major upper limb arteries and persistent humeral head subluxation following emergency reduction. Early surgical exploration of the major axillary vessels was performed by a multi-disciplinary team. The Subscapularis was found reflected into the joint with a fragment of the greater tuberosity. Fracture fixation and reconstruction of the rotator cuff was performed. A review of the literature is included. Avascular necrosis and impaired function are common complications of this injury.