1000232760.jpg
1000232761.jpg
Reduction was done for dislocation
analyse_media
analyse_media
Reading File
Finding Sources
Reading File
Reading File
Finding Sources
Reading File
Based on my analysis of both images and the clinical context, here is my assessment:
Image Analysis - Post-Reduction Evaluation
What the images show:
Image 1 (Plain X-ray AP - Pahlad Prasad, 50Y Male, taken 17-07-26 6:07 PM):
This is the pre-reduction X-ray showing:
- Right shoulder anterior (subcoracoid) dislocation - humeral head displaced medially and inferiorly, sitting below the coracoid process
- Associated displaced fracture of the greater tuberosity - a large bony fragment is seen sheared off and displaced superolaterally
- The glenohumeral joint is not reduced in this film
Image 2 (C-arm / Image Intensifier fluoroscopy - taken 17-07-26 7:33 PM, ~1.5 hours later):
This is the intraoperative/reduction fluoroscopy image - taken during or after the reduction procedure. The image shows:
- The humeral head is now seated in the glenoid fossa - the joint appears reduced
- The glenohumeral articulation looks concentric
- However, the greater tuberosity fragment position needs to be assessed on a formal post-reduction X-ray series
Key Concern - Greater Tuberosity Fracture
This is the critical finding. The patient has an anterior shoulder dislocation with associated greater tuberosity fracture (a fracture-dislocation pattern).
Following closed reduction, the greater tuberosity fracture may:
- Spontaneously reduce to an acceptable position (<5 mm displacement) - this happens in ~70-80% of cases and conservative management is appropriate
- Remain displaced (>5 mm or >10 mm in some criteria) - this requires surgical fixation
Recommended Next Steps
| Step | Action |
|---|---|
| 1 | Post-reduction plain X-rays - AP, scapular-Y, and axillary view to confirm reduction and assess greater tuberosity fragment displacement |
| 2 | Neurovascular check - assess axillary nerve (sensation over "regimental badge" area, lateral deltoid), radial pulse |
| 3 | If GT fragment >5 mm displaced after reduction - refer for orthopedic surgical evaluation (ORIF or arthroscopic fixation) |
| 4 | If GT fragment <5 mm displaced - conservative management: sling immobilization, early physiotherapy at 1-2 weeks |
| 5 | MRI shoulder (within 1-2 weeks) - to assess rotator cuff integrity, Bankart lesion, Hill-Sachs lesion. Rotator cuff tears are found in up to 38% of shoulder dislocations, especially in patients >40 years |
Post-Reduction Immobilization
- Age 50 - this patient is in the intermediate group
- Immobilize in a sling; duration ~2-3 weeks
- Early physiotherapy referral is important to prevent stiffness and adhesive capsulitis
- Follow-up in 5-7 days to assess neurovascular status and GT fracture position
- Oral NSAIDs or analgesics for pain relief
Risk Stratification
This patient has 3 risk factors for clinically significant associated injuries:
- Age >40 years (age 50)
- Likely first/traumatic episode
- Traumatic mechanism
Per [Roberts and Hedges' Clinical Procedures in Emergency Medicine], the presence of these risk factors predicts associated injuries with 97.7% sensitivity - formal imaging follow-up is mandatory here.
Bottom line: The fluoroscopy image suggests reduction was achieved. Obtain a formal post-reduction X-ray series urgently to confirm concentric reduction and assess the greater tuberosity fracture position, as displacement >5 mm may require surgical fixation.
This is a shared conversation. Sign in to Orris to start your own chat.