Effect of closed reduction and external fixation in elderly patients with anterior shoulder dislocation combined with humeral surgical neck fracture: a retrospective cohort study based on fracture-dislocation classification.

BACKGROUND: Anterior shoulder dislocation combined with humeral surgical neck fracture is a severe injury that often requires emergency surgery. However, for some patients, such as those of advanced age or with surgical contraindications, closed reduction can be considered. This retrospective cohort study aimed to confirm the feasibility and clinical outcomes of the closed reduction technique with effective external fixation for the treatment of anterior shoulder dislocation combined with humeral surgical neck fracture in elderly patients. METHOD: From January 2010 to March 2024, a total of 51 patients with anterior shoulder dislocation combined with humeral surgical neck fracture from Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine participated in this study. All patients underwent emergency closed reduction and external fixation. Whether they would be finally included in the statistical analysis was determined based on the post-reduction imaging results. We conducted follow-up for more than one year on the patients who were finally included in the study. We also recorded patients' general characteristics, fracture-dislocation classification (type I, type II, type III), fracture reduction and healing status, as well as the affected limb's function scores. RESULT: After screening, 38 patients were included in the cohort, and ultimately 34 patients completed the follow-up. Among them, there were 11 males and 23 females. Their ages ranged from 65 to 90 years, with an average of (74.15 ± 7.36) years. All 34 patients comprised 15 cases of type I, 14 cases of type II, and 5 cases of type III, respectively. Notably, 64.71% (22/34) of them achieved successful closed reduction, including 13 cases of type I, 9 cases of type II, and no case of type III. At the last follow-up, 8.82% (3/34) and 5.88% (2/34) of patients experienced humeral head ischemic necrosis and nonunion of fractures, respectively. The Constant Murley shoulder function score for conservative treatment patients (n = 21) ranged from 68 to 95 points, with an average of (83.90 ± 6.62) points. CONCLUSION: Emergency closed reduction is feasible for anterior shoulder dislocation combined with humeral surgical neck fracture. Therefore, closed reduction and external fixation should be considered as an optional approach, mainly applicable to elderly patients with reducible Type I or Type II fracture-dislocation classification.