Key result
The superior subacromial approach allowed reduction and osteosynthesis of posterior shoulder fracture-dislocations with minimal risk to the humeral head and its blood supply.
Case Report (n=11)
The superior subacromial approach provides a viable alternative for open reduction of posterior fracture-dislocations of the shoulder with articular segment fractures, avoiding difficulties of anterior approaches.
May support superior subacromial approach in select posterior shoulder fracture-dislocations; leaves open need for comparative trials.
We describe 11 cases of posterior fracture-dislocation of the shoulder that required open reduction and fixation. Difficulties with access through anterior approaches led us to use the superior subacromial approach. This is an extension of the approach often used to expose the rotator cuff; the joint is opened by splitting the supraspinatus tendon 5 mm behind the cuff interval. The glenoid, proximal humerus and any fracture fragments can be seen from above, allowing reduction of the dislocation and osteosynthesis to be performed with minimal risk of damage to the humeral head and its blood supply. The proximity of the axillary nerve limits the exposure of the proximal humeral shaft. The superior subacromial approach is ideal for posterior dislocation with fracture of the articular segment, but is not suitable when there is a fracture of the proximal humeral shaft.
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Stableforth et al. (1992) conducted a case report in Posterior fracture-dislocation of the shoulder (n=11). Superior subacromial approach was evaluated. The superior subacromial approach allowed reduction and osteosynthesis of posterior shoulder fracture-dislocations with minimal risk to the humeral head and its blood supply.
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