PMC9928222_01
Antero-posterior and lateral views of left shoulder on presentation. Demonstrating an anterior dislocation of the humeral head and a displaced fracture of the greater tuberosity. There is also evidence of an acromio-clavicular injury, which was old and not relevant to the current presentation.
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FIG1
PMC9928222_02
Post-reduction anteroposterior radiograph. Demonstrating a successful reduction of the shoulder joint. Note that the greater tuberosity is not so well defined on this view.
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FIG2
His shoulder was reduced under sedation in the ED, with post-reduction radiographs reviewed and accepted as demonstrating a successful joint reduction (Figure 2).
CT scan axial and sagittal images, obtained on presentation to the upper limb fracture clinic. These demonstrate significant displacement of the greater tuberosity fragment in a posterior and superior direction, relevant to the humeral head. Healing in such a position, the patient would experience a mechanical block to external rotation and significant weakness, secondary to mechanical disadvantage of the rotator cuff tendons.. CT: Computerized tomography
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FIG3
Three-dimensional reconstruction images from the patient's CT scan. These give a better impression of the significant displacement of the greater tuberosity fragment and serve to demonstrate how deceptive plain radiographs can be, if not interpreted carefully and with a high index of suspicion.. CT: Computerized tomography
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FIG4
Intra-operative images from the surgical fixation procedure. These demonstrate anatomical reduction of the greater tuberosity fragment, held in place with sutures and a pre-contoured fixed-angle locking plate.
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FIG5
As a result of identifying the displacement, surgical fixation with a locking plate and suture construct was undertaken through a deltoid-splitting approach, seven days following presentation to the ED (Figure 5).
Post-operative antero-posterior and lateral radiographs. These demonstrate anatomical reduction of the tuberosity and an advanced degree of union of this fragment.
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FIG6
Post-operative radiographs taken at that time demonstrated a satisfactory and anatomical position and alignment of the greater tuberosity fragment (Figure 6).