Dr. Turner: This 53-year-old truck driver fell on an icy sidewalk, injuring his left shoulder. Despite considerable pain, marked swelling, and ecchymosis about the shoulder, the patient did not come to the hospital until 24 hours following his injury. Physical examination revealed marked ecchymosis and swelling about the left shoulder. There was no evidence of damage to the circumflex nerve. Circulation and sensation in the upper extremity were normal.
X-ray films demonstrated a fracture-dislocation of the left shoulder with the shaft of the humerus displaced superiorly into the shoulder joint and the humeral head displaced anteriorly and inferiorly. There was comminution of both the greater and lesser tuberosities (Fig 1,2,3).
Dr. Aufranc: This patient has sustained a very severe fracture dislocation of the shoulder with at least four separate fragments visible: the greater tuberosity, the lesser tuberosity, the dislocated humeral head, and the shaft of the humerus. This injury is