Published online Apr 6, 2019. doi: 10.12998/wjcc.v7.i7.849
Peer-review started: November 14, 2018
First decision: December 22, 2019
Revised: February 24, 2019
Accepted: March 8, 2019
Article in press: March 9, 2019
Published online: April 6, 2019
Processing time: 142 Days and 14.9 Hours
Open dislocation of the glenohumeral joint is a very rare complication with only six cases described in the literature. Most cases resulted in severe complications like avascular necrosis of the humeral head or septic arthritis with poor functional results. The “mandatory” treatment of choice is surgery, with accurate debridement and reconstruction of the damaged soft tissues. However, the results in these cases do not approach those seen in classical dislocations.
This case report is the first description of an anterior open glenohumeral dislocation without associated fractures, but with complete avulsion of the soft tissue envelope of the proximal humerus. Surgical treatment consisted of copious lavage with saline solution, meticulous debridement of the nonviable soft tissues, reduction of the dislocated humeral head and reconstruction of the soft tissue envelope of the humeral head. The selected surgical approach was an inferior extension of the wound at the level of the delto-pectoral groove, as the best choice to be able to perform an adequate debridement and capsulo-tendinous reinsertion. At 6 mo there were no clinical signs of instability of the glenohumeral joint, the functionality of the joint was restricted to 90º of anterior elevation, internal rotation to L2, with severe limitation of abduction (60º) and external rotation (0º) but without residual pain, with an Oxford shoulder Score of 28.
Thorough reconstruction of the soft tissues surrounding the shoulder joint and an early rehabilitation program are key points to a good functional result.
Core tip: Open dislocation of the scapulo-humeral joint is a very rare finding in the emergency department and is usually the result of a high velocity trauma. The “mandatory” treatment of choice is surgery, with accurate debridement and reconstruction of the damaged soft tissues. However, the results in these cases do not approach those seen in classical dislocations.