A combination of posterior fracture dislocation of shoulder and ipsilateral clavicle fracture following a road traffic accident: a rare injury pattern treated with internal fixation – a case report

Abstract

Posterior fracture-dislocation of the shoulder is an uncommon injury accounting for a small percentage of all shoulder dislocations and is frequently missed during initial evaluation due to subtle clinical and radiographic findings. The association of posterior proximal humerus fracture-dislocation with an ipsilateral clavicle shaft fracture is exceedingly rare and poses significant diagnostic and therapeutic challenges. Early recognition and stable fixation are essential to restore shoulder girdle anatomy and facilitate rehabilitation and optimal shoulder function. A young man in his twenties presented to the Emergency department (ED) of a level 3 trauma facility following a road traffic accident with complaints of swelling and painful restriction movements of his left shoulder. On clinical and radiological evaluation, he was diagnosed to have a closed posterior fracture dislocation of his left proximal humerus and ipsilateral closed midshaft fracture of the clavicle, He underwent open reduction and internal fixation of both the fractures within 24 hours of his initial presentation. At one year follow up he retains full function of his left shoulder without evidence of any complication. This case highlights the importance of prompt diagnosis and early intervention utilizing meticulous surgical technique for fixing such complex injuries anatomically to restore acceptable shoulder function. This also underlines the importance of long term follow up of such patients to watch for potential complications including osteonecrosis of humeral head, shoulder arthritis and persistent instability.