Surgical treatment of the difficult reduction of shoulder joint dislocation combined with greater tuberosity fracture_West China Medical Journal

Authors：

WAN Yongxian ¹ , YANG Yunkang ¹ , XU Lili ² , ZHUO Naiqiang ¹ , GUO Jianhua ¹ ,  LU Xiaobo ¹

1. Department of Orthopedics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;
2. Department of Rehabilitation Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding?author：

LU Xiaobo, Email: luxiaobo1963@126.com

Keywords：

Shoulder joint; Dislocation; Greater tuberosity of humerus; Fracture

DOI：

10.7507/1002-0179.201608021

Video：

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ObjectiveTo explore the clinical effect of open reduction and internal fixation with hollow screw fixation in the treatment of difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus.MethodsFrom January 2011 to March 2014, 15 patients with difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus were treated with open reduction and hollow screw fixation. There were 9 males and 6 females, aged from 45 to 77 years with an average of 63.5 years. The causes of injury included 7 cases of falls, 5 cases of high falling injury, and 3 cases of traffic accident injury. The injury-to-admission time was 2 hours to 5 days with an average of 1.5 days. The shoulder joint was the initial dislocation. The types of dislocation showed 14 cases of anterior dislocation and 1 case of posterior dislocation. There were 9 cases of simple avulsion fracture of greater tuberosity of humerus, 5 cases of comminuted fracture, 1 case of both greater tuberosity of humeru with small tuberosity of humerus fracture, and 2 cases of incomplete nerve injury; no exploration was carried out in operation.ResultsThere were 14 patients with wound healing at first intention; 1 suffered superficial infection of the wound, which healed by anti infection treatment. Fifteen cases were followed up for 6 to 18 months with an average of 12.2 months, with 1 case of shoulder joint re-dislocation 1 month after operation, and 2 cases of tuberosity of humerus defect absorption. One year after operation, the shoulder joint function were evaluated according to Neer Scoring System, and the results were excellent in 9 cases, good in 3 cases, fair in 2 cases, and poor in 1 case, with the excellent and good rate of 80.0%.ConclusionThe curative effect of open reduction and internal fixation with hollow screw fixation on difficult reduction of shoulder joint dislocation combined with fracture of greater tuberosity of humerus is remarkable, which can obtain satisfactory shoulder joint function.

Citation： WAN Yongxian, YANG Yunkang, XU Lili, ZHUO Naiqiang, GUO Jianhua, LU Xiaobo. Surgical treatment of the difficult reduction of shoulder joint dislocation combined with greater tuberosity fracture. West China Medical Journal, 2018, 33(9): 1090-1093. doi: 10.7507/1002-0179.201608021 Copy

1.	薛子超, 安智全. 合并大結節骨折的肩關節脫位的治療進展. 實用骨科雜志, 2012, 18(11): 997-1000.
2.	黨育, 付中國, 蘆浩, 等. 關節鏡治療肩關節脫位合并肱骨大結節骨折近期療效. 中國修復重建外科雜志, 2009, 23(3): 271-273.
3.	Chechik O, Khashan M, Amar E, et al. Primary anterior shoulder dislocation. Harefuah, 2011, 150(2): 117-121, 206.
4.	徐圣康, 羅斌, 趙猛, 等. anchor 結合 krackow 縫合法在肱骨大結節骨折及肩袖損傷中應用的療效觀察. 中華臨床醫師雜志: 電子版, 2012, 6(13): 3793-3794.
5.	王亨火, 張福強, 林進椂, 等. 難復性肱骨大結節撕脫先骨折伴肩關節脫位的手術治療初步分析. 中國醫學創新, 2013, 10(1): 99-100.
6.	Mckeon BP, Heming JF, Fulkerson J, et al. The krackow stitch: a biomechanical evaluation of changing the number of loops versus the number of sutures. Arthroscopy, 2006, 22(1): 33-37.
7.	俞銀賢, 朱力波, 馬金忠, 等. 創傷性肩關節后脫位的診斷與治療. 中華關節外科雜志: 電子版, 2012, 6(1): 23-28.
8.	曹烈虎, 翁蔚宗, 宋紹軍, 等. 微創空心釘與切開復位鋼板內固定治療肱骨大結節骨的療效比較. 中國修復重建外科雜志, 2013, 27(4): 418-422.
9.	George MS. Fractures of the greater tuberosity of the humerus. J Am Acad Orthop Surg, 2007, 15(10): 607-613.
10.	Park TS, Choi IY, Kim YH, et al. A new suggestion for the treatment of minimally displaced fractures of the greater tuberosity of the proximal humerus. Bull Hosp Jt Dis, 1997, 56(3): 171-176.
11.	Choo A, Sobol G, Maltenfort M, et al. Prevalence of rotator cuff tears in operative proximal humerus fractures. Orthopedics, 2014, 37(11): e968-e974.
12.	喻都, 肖海軍, 石偉哲, 等. 手術治療老年陳舊性肩關節脫位的療效觀察. 中國修復重建外科雜志, 2015, 29(9): 1076-1079.
13.	溫輝林, 萬乃明, 胡利典, 等. 新鮮難復性肩關節脫位 1 例報告. 骨科, 2012, 3(1): 54.
14.	陳優民, 黃際河, 李群, 等. 可吸收螺釘結合可吸收線張力帶內固定治療肱骨大結節骨折. 臨床骨科雜志, 2012, 15(1): 20.
15.	曲振明. 空心釘內固定治療肩關節脫位合并大結節骨折. 中國實用醫藥, 2011, 6(13): 88-89.
16.	徐云欽, 李強, 申屠剛, 等. 三種手術方法在肩關節脫位合并肱骨大結節撕脫骨折中的應用. 中國骨與關節損傷雜志, 2012, 27(3): 203-205.
17.	高述玲, 林治建, 叢培軍, 等. 解剖鎖定鋼板內固定治療肱骨大結節骨折. 中國骨與關節損傷雜志, 2012, 27(1): 90-91.
18.	沈福祥. 肱骨大結節骨折 67 例治療分析. 中國現代醫生, 2011, 49(7): 112-113.
19.	王永. 多根縫線張力帶縫合固定術治療粉碎性肱骨大結節骨折療效觀察. 山東醫藥, 2014, 54(46): 72-73.
20.	趙晨, 商培洋, 車凌賓, 等. 鎖定鋼板治療老年肱骨近端骨折合并肩袖撕裂的療效分析. 中華老年骨科與康復電子雜志, 2015, 1(1): 22-27.
21.	Senekovic V, Poberaj B, Kovacic L, et al. Prospective clinical study of a novel biodegradable sub-acromial spacer in treatment of massive irreparable rotator cuff tears. Eur J Orthop Surg Traumatol, 2013, 23(3): 311-316.

1. 薛子超, 安智全. 合并大結節骨折的肩關節脫位的治療進展. 實用骨科雜志, 2012, 18(11): 997-1000.
2. 黨育, 付中國, 蘆浩, 等. 關節鏡治療肩關節脫位合并肱骨大結節骨折近期療效. 中國修復重建外科雜志, 2009, 23(3): 271-273.
3. Chechik O, Khashan M, Amar E, et al. Primary anterior shoulder dislocation. Harefuah, 2011, 150(2): 117-121, 206.
4. 徐圣康, 羅斌, 趙猛, 等. anchor 結合 krackow 縫合法在肱骨大結節骨折及肩袖損傷中應用的療效觀察. 中華臨床醫師雜志: 電子版, 2012, 6(13): 3793-3794.
5. 王亨火, 張福強, 林進椂, 等. 難復性肱骨大結節撕脫先骨折伴肩關節脫位的手術治療初步分析. 中國醫學創新, 2013, 10(1): 99-100.
6. Mckeon BP, Heming JF, Fulkerson J, et al. The krackow stitch: a biomechanical evaluation of changing the number of loops versus the number of sutures. Arthroscopy, 2006, 22(1): 33-37.
7. 俞銀賢, 朱力波, 馬金忠, 等. 創傷性肩關節后脫位的診斷與治療. 中華關節外科雜志: 電子版, 2012, 6(1): 23-28.
8. 曹烈虎, 翁蔚宗, 宋紹軍, 等. 微創空心釘與切開復位鋼板內固定治療肱骨大結節骨的療效比較. 中國修復重建外科雜志, 2013, 27(4): 418-422.
9. George MS. Fractures of the greater tuberosity of the humerus. J Am Acad Orthop Surg, 2007, 15(10): 607-613.
10. Park TS, Choi IY, Kim YH, et al. A new suggestion for the treatment of minimally displaced fractures of the greater tuberosity of the proximal humerus. Bull Hosp Jt Dis, 1997, 56(3): 171-176.
11. Choo A, Sobol G, Maltenfort M, et al. Prevalence of rotator cuff tears in operative proximal humerus fractures. Orthopedics, 2014, 37(11): e968-e974.
12. 喻都, 肖海軍, 石偉哲, 等. 手術治療老年陳舊性肩關節脫位的療效觀察. 中國修復重建外科雜志, 2015, 29(9): 1076-1079.
13. 溫輝林, 萬乃明, 胡利典, 等. 新鮮難復性肩關節脫位 1 例報告. 骨科, 2012, 3(1): 54.
14. 陳優民, 黃際河, 李群, 等. 可吸收螺釘結合可吸收線張力帶內固定治療肱骨大結節骨折. 臨床骨科雜志, 2012, 15(1): 20.
15. 曲振明. 空心釘內固定治療肩關節脫位合并大結節骨折. 中國實用醫藥, 2011, 6(13): 88-89.
16. 徐云欽, 李強, 申屠剛, 等. 三種手術方法在肩關節脫位合并肱骨大結節撕脫骨折中的應用. 中國骨與關節損傷雜志, 2012, 27(3): 203-205.
17. 高述玲, 林治建, 叢培軍, 等. 解剖鎖定鋼板內固定治療肱骨大結節骨折. 中國骨與關節損傷雜志, 2012, 27(1): 90-91.
18. 沈福祥. 肱骨大結節骨折 67 例治療分析. 中國現代醫生, 2011, 49(7): 112-113.
19. 王永. 多根縫線張力帶縫合固定術治療粉碎性肱骨大結節骨折療效觀察. 山東醫藥, 2014, 54(46): 72-73.
20. 趙晨, 商培洋, 車凌賓, 等. 鎖定鋼板治療老年肱骨近端骨折合并肩袖撕裂的療效分析. 中華老年骨科與康復電子雜志, 2015, 1(1): 22-27.
21. Senekovic V, Poberaj B, Kovacic L, et al. Prospective clinical study of a novel biodegradable sub-acromial spacer in treatment of massive irreparable rotator cuff tears. Eur J Orthop Surg Traumatol, 2013, 23(3): 311-316.

West China Medical Journal

Surgical treatment of the difficult reduction of shoulder joint dislocation combined with greater tuberosity fracture

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