case_images: PMC11221983_01
case_images: Initial plain radiographic images on first referral to our hospital. (a) An anteroposterior radiograph showing a light bulb-like appearance of the humeral head with a malunited greater tuberosity. (b) A scapular Y view showing the posterior shift of the humeral head.
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case_images: fig1
case_images: Anteroposterior plain radiography revealed a light bulb-like appearance of the humeral head with a malunited fracture of the greater tuberosity (Figure 1(a)). A scapular radiographic Y view showed a posterior shift of the humeral head (Figure 1(b)).
case_images: Preoperative CT. (a) Axial and (b) sagittal views showing posterior shoulder dislocation with a malunited greater tuberosity and a small glenoid fracture of the posterior portion. (c, d) 3D reconstruction of the CT images. (d) The humerus was removed to observe the glenoid. Asterisk: greater tuberosity; white arrowhead: glenoid fracture. CT: computed tomography; 3D: three dimensional.
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case_images: fig2
case_images: CT images showed posterior dislocation with a malunited greater tuberosity and a small bone fracture of the posterior glenoid (Figure 2).
case_images: Preoperative MRI. (a) A coronal view showing an intact rotator cuff supraspinatus tendon. (b) The axial view showing an intact rotator cuff and subscapularis and infraspinatus tendons and no dislocation of the long head of the bicep tendon. Asterisk: greater tuberosity; white arrowhead: intact rotator cuff. MRI: magnetic resonance imaging.
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case_images: fig3
case_images: Magnetic resonance imaging (MRI) revealed an intact rotator cuff; however, the infraspinatus and teres minor tendons appeared to be thin because the humeral head had dislocated posteriorly (Figure 3).
case_images: Intraoperative view. (a) A malunited greater tuberosity was observed using the deltopectoral approach. The greater tuberosity protrudes just lateral to the intertubercular groove. (b) Following a release of the groove, the long head of the bicep tendon was observed. A malunited greater tuberosity is easily recognizable. Asterisk: greater tuberosity; white arrowhead: long head of bicep tendon.
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case_images: fig4
case_images: The malunited greater tuberosity protruded lateral to the intertubercular groove (Figure 4(a)). We opened the groove to reveal the long head of the bicep tendon (Figure 4(b)).
case_images: Plain radiographic images on postoperative Day 1. (a) AP view, (b) Y view.
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case_images: fig5
case_images: The greater tuberosity was reduced, and internal fixation with a plate (Axsos 3 Ti Proximal Humerus Plating System; Stryker, MI, USA) was performed under external rotation to avoid dislocation posteriorly (Figure 5).
case_images: Postoperative CT and MRI examinations. (a) CT on postoperative Day 1. (b) MRI 3 months postoperatively. (c) CT images taken 12 months postoperatively. The centric position of the humeral head showing gradual improvement. CT: computed tomography; MRI: magnetic resonance imaging.
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case_images: fig6
case_images: A CT scan on postoperative Day 1 showed posterior subluxation of the humeral head (Figure 6(a)). A 3-month postoperative MRI (Figure 6(b)) and a 12-month postoperative CT scan showed gradual improvement in the centric position of the humeral head (Figure 6(c)).
case_images: Plain postoperative radiographic images. Plain postoperative radiographic images taken at 24 months postoperatively. (a) AP view, (b) Y view.
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case_images: fig7
case_images: At 18 months postoperatively, he underwent implant plate removal (Figure 7).
case_images: Final follow-up at 24 months postoperatively. (a, b) Active elevation. (c) Active external rotation. (d) Active internal rotation.
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case_images: fig8
case_images: At 24 months postoperatively, his functional status was maintained, no complications were observed (Figure 8), and his Constant-Murley score had improved to 93.