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

Abstract

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. Discussion: A two-stage surgical approach enabled early reduction to restore alignment and prevent neurovascular injury, while delayed fixation allowed for improved visualisation and precise anatomical reduction. Combining screw and suture anchor techniques provided secure fixation while minimising soft tissue disruption. Conclusion: This case highlights the clinical value of staged management in complex shoulder injuries. Delayed ORIF following closed reduction allowed safer and more controlled fixation. Structured rehabilitation remains essential for functional recovery in active patients.