title: The "triple dislocation fracture": anterior shoulder dislocation with concomitant fracture of the glenoid rim, greater tuberosity and coracoid process-a series of six cases.
abstract: BACKGROUND
  A combined fracture of the glenoid rim, greater tuberosity, and coracoid process after anterior shoulder dislocation is a rare event. Only 1 patient has been reported in the literature.
  
  
  METHODS
  All patients with a first-time traumatic anterior shoulder dislocation in a level A trauma center were retrospectively reviewed. Among the 2068 patients treated between 1998 and 2013, we identified 6 patients (0.3%; 1 female, 5 male) with "triple dislocation fracture" (anterior shoulder dislocation with concomitant fracture of the glenoid rim, greater tuberosity, and coracoid process). All patients underwent surgery and had computed tomography scans before surgery and the first postoperative day. Mean follow-up time was 59 months. Clinical and radiographic evaluation, Constant-Murley Score, Simple Shoulder Test, and Subjective Shoulder Value were performed at the final follow-up.
  
  
  RESULTS
  Surgery was determined individually according to the radiologic findings, patient's age, and personal demands. Glenoid reconstruction was performed in all 6 patients, greater tuberosity refixation in 4 patients, and coracoid process refixation in 3. Two patients needed revision surgery due to loss of reduction. At the final follow-up, mean abduction was 133°, mean anterior flexion was 138°; the mean Constant-Murley Score was 72 points; the mean Simple Shoulder Test was 9 points; and the mean Subjective Shoulder Value was 72%. No recurrent instability occurred.
  
  
  CONCLUSIONS
  A "triple dislocation fracture," especially coracoid process fractures, can easily be overlooked in radiographs. Computed tomography scans are strongly recommended in patients with a first-time traumatic shoulder dislocation. Because recurrent joint instability and secondary arthropathy are serious complications after anterior shoulder dislocation, surgery should be considered and provides satisfying to excellent results.
authors.affiliation: Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria; Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors.forename: Fabian
authors.initials: F
authors.lastname: Plachel
authors.affiliation: Department of Trauma Surgery, AUVA Trauma Center Meidling, Vienna, Austria.
authors.forename: Jakob E
authors.initials: JE
authors.lastname: Schanda
authors.affiliation: Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Ortmaier
authors.affiliation: Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Auffarth
authors.affiliation: Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors.forename: Herbert
authors.initials: H
authors.lastname: Resch
authors.affiliation: Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria. Electronic address: r.bogner@salk.at.
authors.forename: Robert
authors.initials: R
authors.lastname: Bogner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000070597:Coracoid Process / Q000293:injuries*; D005260:Female; D000072039:Fracture Dislocation / Q000000981:diagnostic imaging / Q000601:surgery*; D005593:Fracture Fixation, Internal; D006801:Humans; D008297:Male; D008875:Middle Aged; D016059:Range of Motion, Articular; D012086:Reoperation; D012189:Retrospective Studies; D012540:Scapula / Q000293:injuries*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Anterior shoulder dislocation; coracoid process fracture; functional outcome; glenoid fracture; greater tuberosity fracture; surgery