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Fracture Dislocations of the Shoulder


- See:
        - Anterior Dislocation of the Shoulder
        - Posterior Shoulder Dislocation
        - Proximal Humeral Fracture
        - Three Part Fracture Dislocation

- Discussion:
    - frx dislocations may be considered an extension of two,  three, and four part frx classifictions;
    - ultimate prognosis depends on the appearance of AVN and nonunion;
    - presence of atleast one intact tuberosity usually ensures enough blood supply to prevent AVN;
    - exam considerations:
          - note high prevelence of axillary nerve palsy, which may manifest as an postoperative pseudoparalysis with inferior subluxation;

- Two Part Fracture Dislocation:
    - 2 part anterior frx dislocation is associated w/ an avulsed greater tuberosity, or can occur thru the surgical neck;
    - in older pts w/ anterior humeral head dislocations, massive cuff tears are more common than avulsions;
    - satisfactory reductions w/ or w/o GEA is often acheived;
    - in almost all cases, closed reductions w/ no surgical rx is indicated;
    - in rare cases, long head of the biceps tendon may block reduction, necessitating ORIF;

- Three Part Fracture Dislocations:
    - shoulder replacement



Acute prosthetic replacement for severe fractures of the proximal humerus.