Post-reduction reclassification dilemma in proximal humeral fracture-dislocation: A case report and practical considerations.

INTRODUCTION

Proximal humeral fracture-dislocations (PHF-D) are complex injuries, often requiring urgent intervention. However, management protocols remain unclear when anatomical reduction of the glenohumeral joint is achieved, but significant displacement of the greater tuberosity persists. The lack of consensus on whether to reclassify such injuries after reduction creates uncertainty in rehabilitation strategies.

PRESENTATION OF CASE: We present the case of a 53-year-old female who suffered an anterior shoulder dislocation with a displaced greater tuberosity fracture after falling due to a traffic accident. After successful closed reduction of the shoulder joint, the greater tuberosity fragment remained displaced (>1 cm). Open reduction and internal fixation were performed. The patient recovered well, achieving a near-normal range of motion and full return to activities without neurovascular complications.

DISCUSSION: The central dilemma in this case was whether to maintain the initial Neer group VI classification (fracture-dislocation) or to reclassify the injury as an isolated greater tuberosity fracture (Neer group IV) following reduction. This decision directly influenced the rehabilitation protocol and outcome prediction. Current literature does not provide clear guidelines for post-reduction reclassification, making clinical decision-making challenging. We present a pragmatic, literature-informed decision-aid, not a replacement for established classifications.

CONCLUSION

Post-reduction classification in PHF-D is a significant gap in current practice. Recognizing and addressing this issue can help optimize management strategies and improve patient outcomes.