Luxatio erecta

Luxatio erecta humeri: Report of a swimming injury with analysis of the mechanism of the injury and associated injuries in literature

Inferior shoulder dislocation also referred to as luxatio erecta is an unusual and rare type of shoulder dislocation. Its incidence is about 0.5% among all shoulder dislocations. After an exhaustive search of all the available literature we were unable to find a swimming accident case that did not have other associated injuries and an uneventful reduction. The mechanism of the injury was mostly related to direct axial loading and indirect hyperabduction lever arm. We would like to emphasize the importance of this being a swimming accident, a type of accident that requires awareness of the possibility of dangerous asphyxia injuries caused by panic in the water (swimming pool, river, lake, sea, etc.). We described the nature of the injury and review the literature concerning the mechanism of the injury and associated neurovascular impairment at admission time. We also presented a supplemental video to contribute to the education of young residents and orthopedic surgeons.

[Dislocation erecta]

La luxation de l'épaule dans sa forme erecta est une variété rare elle représente 0.5% de toute les luxations de l'épaules. Peu de cas ont été signalés, et le résultat du traitement a été mal défini. Entre 2001 et 2010, 09 patients avec luxation erecta ont été évalue dans notre formation. Il s'agit de huit hommes et une femme d’âge moyen de 31,5 ans. L'épaule droite était luxée dans sept cas, et le mécanisme était direct chez deux patients. L'attitude de l'épaule a été typique dans tous les cas avec un membre supérieur en abduction forcée, bras en l'air et impossibilité de ramener le coude au corps. Aucun trouble vasculaire n'a été noté par contre une atteinte nerveuse a été retrouvé dans 5 cas avec une évolution simple. La radiographie de l'épaule de face a objectivé une luxation inférieure de la tête humérale et un axe diaphysaire au-dessus de l'horizontale dans toutes nos observations. Le traitement a consisté en une réduction sous anesthésie générale suivie d'un bandage type Dujarier pendant trois semaines. La luxation de l'épaule type erecta constitue la forme type de la luxation inférieure, son mécanisme est une chute sur le membre supérieur en grande abduction ou antépulsion. Le diagnostic clinique est facile, confirmé par la radiographie de l'épaule de face. Le pronostic fonctionnel à long terme est excellent.

[Luxatio erecta of the shoulder. Report of eight cases]

The luxatio erecta is a rare form of shoulder dislocation frequently described in young patients. The purpose of our study is to review the mechanism of this affection as well as its clinical, radiographic and therapeutic features. We also report eight cases of luxatio erecta observed between 1995 and 2006. We report six males and two females with an average age of 40 years. The left shoulder was dislocated in seven cases and a direct mechanism was reported by two patients. All of our cases presented with the typical attitude described for this dislocation; an upper limb in fixed abduction with the hand raised and inability to bring the elbow back to the body. No neurovascular injury was reported in this study. Radiographic examination showed inferior dislocation of the humeral head and the axis of the shaft above the horizontal line in all of our cases. The treatment consisted of closed reduction under general anaesthesia followed by a Dujarier's bandage for three weeks. Luxatio erecta is the commonest type of inferior dislocation. Its mechanism is a fall on the upper limb in great abduction or antepulsion. The clinical diagnosis is easy, confirmed by an anteroposterior radiograph. The functional long-term prognosis is excellent.