![]() In this case the humeral head impaction fracture was locked on the glenoid and the force of external rotation split the humerus open at the site of impaction. We feel that this was a fracture caused by the manipulation and implicate the external rotation part of the Kocher's method. ![]() Finally, the arm is slowly rotated medially'. The externally rotated arm is raised in the sagittal plane as far as it will go in a forward direction. The arm is externally rotated until resistance is experienced. It states 'the arm, bent at the elbow is pressed against the body. The Kocher's method described in 1870 is used for the relocation of anterior shoulder dislocations. It is important to consider gentle stretching of the posterior cuff and capsule by maximally internally rotating the arm before attempting to reduce the dislocation. ![]() External rotation at this stage will relocate the shoulder, but it should not be attempted before the defect has been fully disengaged, as there is a risk of fracturing the humerus. This mechanical block is disimpacted by clearing the impaction fracture from the glenoid lip by gentle manipulation with the arm being flexed to 90 degrees and adducted. In an isolated posterior shoulder dislocation the impaction fracture of the anterior humeral head (reverse Hill-Sachs) sits on the posterior aspect of the glenoid causing a mechanical block. Late diagnosis is a poor prognostic factor in shoulder dislocation. Despite advances in imaging, posterior shoulder dislocations are frequently missed and diagnosed later. The key to diagnose the dislocation is a high index of suspicion and performing adequate radiological investigations. Posterior dislocation is often overlooked and early diagnosis is a key for successful treatment. High energy trauma causes posterior dislocation when an axial force is applied to the arm with the shoulder in internal rotation, flexion and adduction. Posterior shoulder dislocation is uncommon, and most frequently occurs following seizures or trauma.
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