Two-Stage Surgical Management of Anterior Shoulder Dislocation with Greater Tuberosity Fracture in a Young Athlete: A Case Report

Introduction

Anterior glenohumeral dislocation with a Neer two-part fracture involving the greater tuberosity is uncommon but significant in young, active individuals. Prompt and appropriate management is critical to restore shoulder biomechanics and prevent long-term dysfunction. Presentation of Case: A 24-year-old right-hand-dominant male sustained acute right shoulder pain after a basketball injury. Clinical examination revealed tenderness over the proximal humerus without neurovascular compromise. Radiographs confirmed anterior dislocation with a displaced greater tuberosity fragment. Initial management involved analgesia and immobilisation. Closed reduction was performed under general anaesthesia using Matsen’s traction-countertraction technique, followed by immobilisation in a collar and cuff. Two days later, elective open reduction and internal fixation (ORIF) was performed using a single partially threaded cancellous screw with a washer, reinforced with a suture anchor and non-absorbable polyester sutures to preserve rotator cuff function. Intraoperative challenges included achieving stable fixation of a comminuted fragment without impingement. Postoperative radiographs confirmed satisfactory alignment. At the 14-day follow-up, the patient demonstrated a DASH score of 65 and a Constant-Murley Score of 42, indicating early postoperative limitation.