PMC9974937_01
Preoperative X-ray of the patient's right shoulder depicting the anteromedial defect over the head of the humerus. (A) Anteroposterior view. (B) Axillary view.
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FIG1
On the preoperative AP and axillary X-rays of the right shoulder, a defect was seen on the anteromedial aspect of the humerus (Figure 1) and the CT scan showed the posterior shoulder fracture dislocation.
CT scan depicts the extent of the defect.
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FIG2
It also helped in quantifying the bone defect (Figure 2) showing impaction fracture involving >40% of the humeral head.
Patient positioning and surgical site preparation.
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FIG3
Scrubbing, painting, draping, and marking of the surgical site incision were done (Figure 3) from the distal to the lateral edge of the clavicle and just lateral to the coracoid process.
Sutures through the subscapularis tendon.
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FIG4
After exposure, a frayed and thinned-out tendon of the long head of the biceps was noted, for which a tenotomy was done (Figure 4).
Osteotomized lesser tuberosity bone chunk.
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FIG5
Lesser tuberosity bone chunk fixed with a cannulated cancellous screw.
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FIG6
A measured partially threaded, cannulated screw with a washer was placed over the guide wire to achieve compression of the fragment of lesser tuberosity onto the humeral defect (Figure 6).
Postoperative X-ray of the patient with the bone chunk over the defect and implant in situ. (A) Anteroposterior view. (B) Lateral view of the proximal humerus.
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FIG7
Figure 7 showed the immediate postoperative X-ray where the defect over the anteromedial aspect of the humerus is covered with the lesser tuberosity bone chunk and with implants in situ.
Follow-up after six months with (A) forward flexion of 130 degrees, (B) external rotation of 30 degrees; and (C) internal rotation till L4.
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FIG8
The patient had no symptoms and had a pain-free, stable shoulder joint at the time of the last checkup (Figure 8).