Shoulder dislocation and greater tuberosity fracture with isolated radial nerve palsy: A case report and review of management options

Abstract

The glenohumeral joint of the shoulder is the most dislocateable joint in the human body, and the anterior dislocation is the most frequent type. Associated fractures occur in approximately 30% of the shoulder dislocations. The most common fractures include the Hill Sachs lesion (compression fracture in the posterolateral aspect of the humeral head) by 54-76% and avulsion fracture of greater tuberosity 15-30%. Accompanied nerve injury is rare complications, such as the axillary nerve, which is the most commonly injured nerve with an incidence of 9-10%, and to a rarer extent the brachial plexus injury, and the rarest type of nerve injury is an injury to the radial nerve.We discuss a case of a 60-year-old lady who presented with an anterior dislocation of the right shoulder complicated by greater tuberosity fracture after a fall on her hand with a wrist drop. Neurological examination revealed complete radial nerve palsy. Closed reduction with the Kocher method was done at the emergency department under sedation to reduce the dislocated glenohumeral joint, then an arm sling was used to immobilize the shoulder and wrist support for wrist drop. Definitive treatment with open reduction and internal fixation for displaced greater tuberosity fracture with multiple (ethibond) sutures, suture Anchor, and one cannulated screw were done after a few days. The physiotherapy program was started post-operatively for the wrist and fingers to maintain a passive range of motion, while shoulder physiotherapy was started 3 weeks after surgery.isolated radial nerve injury with shoulder dislocation is very rare, so complete neurological assessment is mandatory for proper management and prevention of future complications and to enhance full recovery.