UNUSUAL FRACTURE-SUBLUXATIONS OF THE SHOULDER JOINT

¹ Orthopaedic and Fracture Services, St. Luke's Hospital, New York City

Fracture-subluxations are an entity and should be so classified. They represent theprimary stage of a fracture-dislocation of the humeral head with partial tearing of the capsule.

There has been an incidence of 20 per cent. of subluxation among cases of fracture of the surgical neck at St. Luke's Hospital. This incidence will undoubtedly be higher as routine roentgenograms are taken in both the anteroposterior and lateral views with the patient standing, especially if horizontal gravity exercises have been performed to relieve muscle spasm.

Early surgery directed at correction of the subluxation is not indicated, but surgery may be necessary to correct the position of the fracture fragments. The hanging cast has no place in the treatment of this complication of a fractured surgical neck. Sling support with early horizontal gravity exercises will, in the majority of the cases, produce a satisfactory result. In none of our cases was the subluxation permanent. In all, the subluxation corrected itself within six weeks of the date of fracture. All the sholders were stable at follow-up examination, when the roentgenograms were taken with vigorous traction and with an upward push. If permanent instability or subluxation should be present, it may be necessary to do some type of capsular repair, such as the Bankart procedure.

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