Iatrogenic fracture during shoulder dislocation reduction: characteristics, management and outcomes

Abstract

Background: Shoulder dislocation and the cases of iatrogenic fractures during manual reduction are becoming increasingly common. The aim of this study was to investigate the characteristics, management, and patient outcomes of iatrogenic proximal humeral fracture during the manual reduction of shoulder dislocation. Methods: A retrospective and multi-center study was performed to identify all patients presenting with shoulder dislocation from January 2010 to January 2020. The sex and age of patients, associated injuries, first-time or habitual shoulder dislocation, type of anesthesia, time from injury to revision surgery, and functional outcomes were analyzed. Results: A total of 359 patients with a mean age of 62.1 ± 7.3 years (range 29–86 years) were included. Twenty-one patients (female/male ratio 17:4) with an average age of 66.3 ± 9.7 years (range 48–86 years) were identified with a post-reduction iatrogenic fracture. Female cases with greater tuberosity fractures (GTF) were more likely than male cases to have iatrogenic fractures during reduction (P = 0.035). Women aged 60 years or older experienced more iatrogenic fractures during manual reduction (P = 0.026). Closed reduction under conscious sedation was more likely than that under general anesthesia to have iatrogenic fractures (P = 0.000). A total of 21 patients underwent open reduction and internal fixation (ORIF) when iatrogenic fractures occurred. The mean follow-up period was 19.7 ± 6.7 months (range 12–36 months). The mean Neer scores were 80.5 ± 7.6 (range 62–93), and the mean visual analog score (VAS) was 3.3 ± 1.5 (range 1–6). Significant differences were observed in the Neer score and VAS with the time (more or less 8 h) from injury to revision surgery (P < 0.05). Conclusion: A high risk of iatrogenic proximal humeral fracture is present in shoulder dislocation with GTF in senile females without general anesthesia. ORIF performed in a timely manner may help improve functional outcomes in the case of iatrogenic injury.