Open reduction and plate fixation results in shoulder fracture dislocations

Objective: Fracture dislocations of shoulder are more rare and surgically more challenging in society than the other fractures. In our study, we evaluated the clinical and radiological results of patients with shoulder fracture dislocation operated with open reduction and plate screw fixation technique. Material and method: Between January 2009 and January 2016, 17 patients were treated with open reduction and plate screw fixation due to shoulder fracture dislocation at Department of Orthopedics and Traumatology, Dicle University Faculty of Medicine. Patients were operated within mean 1.11 days (0-4) . Patients were divided into 2 groups according to age. Group 1, consisted of 6 patients over 65 years of age and the mean age was 77.5 (69-87). Group 2, consisted of 11 patients under 65 years of age and the mean age was 41.6 (24-60). All of the Group 1 was composed of female patients and all of the Group 2 consisted of male patients. Patients' radiographs were classified according to Neer Classification. In clinical evaluation of the patients, Oxford Shoulder Score, DASH (Disability of the Arm, Shoulder and Hand) Score and Constant Murley Score were used. Postoperative avascular necrosis of the patients was evaluated according to the Cruess Classification. Results: The mean follow-up period of the patients was 13.8 months (10-38). There was no statistically significant relationship between fracture type, trauma cause and clinical outcomes (p> 0.05). There was a statistically significant difference between Oxford and DASH scores in the clinical outcome according to age groups (p = 0,001, p = 0,049) . The clinical outcomes of Group 2 were better than Group 1. Avascular necrosis was observed in 14 of 17 patients (82.3%) at different stages. The distribution was 72.7% of patients in Group 1 and all of the patients in Group 2. There was statistically significant correlation between development of avascular necrosis according to age groups (p <0,022) . The stage and the prevalence of avascular necrosis increased as age increased. There was a statistically significant difference between Oxford and Constant Murley scores in clinical outcome according to stage of avascular necrosis (p = 0,013, p = 0,028) . Conclusion: Although shoulder fracture dislocations are rarely seen, can cause high loss of function in the upper extremity and still have no common opinion about the surgical technique. Open reduction and internal fixation with plate in shoulder fracture dislocations have been seen as an effective treatment method which can be preferred with adequate surgical technique knowledge and effective postoperative shoulder rehabilitation especially in young and active patient group. In older patients, it can be considered as the last chance before the shoulder replacement surgery in fracture types with less fragments and displacements and in cases with less soft tissue damage, taking into account the presence of additional diseases that affect bone quality and healing. Keywords: Shoulder, fracture, dislocation, open reduction, plate fixation, avascular necrosis.