Atypical posterior fracture-dislocation of the proximal humerus: Arthroscopic reduction and fixation [Frattura-lussazione posteriore atipica dell'omero prossimale: Riduzione ed osteosintesi artroscopica]

The case of a 19 years old caucasian male, involved in a car accident and reporting an atypical posterior fracture-dislocation of the right proximal humerus is described. Classification of the fracture according to Neer's 4 fragments criteria, was not applicable even if a CT scan of the shoulder was obtained in the emergency room. The patient was taken to the operative room, the dislocation was easily reduced under general anaesthesia by means of gentle manual manoeuvres and an arthroscopy of the right shoulder was performed in the beach chair position. The arthroscopic gleno-humeral joint inspection revealed the morphology of the fracture, consisting of a proximal humerus fragment including the bicipital groove, part of the lesser tuberosity and a portion of the greater tuberosity. The reduction of the fragment was performed percutaneously by means of two 1.5 mm K-wires employed as levers to make it slide back in the original distal position, under direct arthroscopic control Then, a 7 mm partially threaded cannulated screw was inserted in the greater tuberosity. The anterior portion of the fragment was secured by means of a suture anchor and a stitch passed through the subscapularis tendon and locked with a DTK knot.