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17 Mar 2024
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Anterior Shoulder Subluxation with Anterior Glena Fracture

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Clinical Details

Clinical and radiological findings:  A 68-year-old female patient suffers a fall from her own height, resulting in a direct bruise on the left shoulder. Initial evaluation revealed no relevant medical history. Physical examination showed pain and functional limitation of the affected shoulder, with no apparent neurovascular compromise. The initial radiograph identified an anterior subluxation of the shoulder with a fracture at the level of the anterior glenoid. Computed tomography confirmed the injury, involving approximately 20% of the glenoid surface.

Preoperative Plan

Planning remarks:  The surgical plan included beach chair positioning for the patient, with a deltopectoral approach planned for fracture exposure. The need for tenotomy of the subscapularis muscle was anticipated to adequately access the affected articular facet. Fracture fixation was planned using two 3.5mm cannulated screws, followed by repair of the subscapularis tendon with anchors.

Surgical Discussion

Patient positioning:  The patient was placed in a beach chair position, optimizing access to the left shoulder and facilitating intraoperative management.

Anatomical surgical approach:  A deltopectoral approach was performed, starting at the lateral border of the pectoralis major muscle and extending distally towards the humerus. The soft tissue was carefully preserved and a tenotomy of the subscapularis muscle was performed to expose the articular surface of the glenoid.

Operative remarks: 

During surgery, it was confirmed that the lesion involved approximately 20% of the anterior glenoid surface. The fracture was fixed using two 3.5mm cannulated screws, ensuring adequate stability and alignment of the bone fragments. The subscapularis tendon was subsequently repaired using anchors, restoring rotator cuff integrity and promoting optimal functional recovery.

Postoperative protocol:   No especificado.

Follow up:   No especificado.

Orthopaedic implants used:   Two 3.5mm cannulated screws, anchors for tendon repair.

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LUIS LEONCIO TEMOCHE DIAZ
  • Peru , Lima
  • Area of Specialty - Shoulder
  • Position - Specialist Consultant
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