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. 合并大结节骨折的肩关节脱位的治疗进展. 实用骨科杂志, 2012, 18(11): 997-1000.
2.	党育, 付中国, 芦浩, 等. 关节镜治疗肩关节脱位合并肱骨大结节骨折近期疗效. 中国修复重建外科杂志, 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, 罗斌, 赵猛, 等. anchor 结合 krackow 缝合法在肱骨大结节骨折及肩袖损伤中应用的疗效观察. 中华临床医师杂志: 电子版, 2012, 6(13): 3793-3794.
5.	王亨火, 张福强, 林进椂, 等. 难复性肱骨大结节撕脱先骨折伴肩关节脱位的手术治疗初步分析. 中国医学创新, 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.	俞银贤, 朱力波, 马金忠, 等. 创伤性肩关节后脱位的诊断与治疗. 中华关节外科杂志: 电子版, 2012, 6(1): 23-28.
8.	曹烈虎, 翁蔚宗, 宋绍军, 等. 微创空心钉与切开复位钢板内固定治疗肱骨大结节骨的疗效比较. 中国修复重建外科杂志, 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, 肖海军, 石伟哲, 等. 手术治疗老年陈旧性肩关节脱位的疗效观察. 中国修复重建外科杂志, 2015, 29(9): 1076-1079.
13.	温辉林, 万乃明, 胡利典, 等. 新鲜难复性肩关节脱位 1 例报告. 骨科, 2012, 3(1): 54.
14.	陈优民, 黄际河, 李群, 等. 可吸收螺钉结合可吸收线张力带内固定治疗肱骨大结节骨折. 临床骨科杂志, 2012, 15(1): 20.
15.	曲振明. 空心钉内固定治疗肩关节脱位合并大结节骨折. 中国实用医药, 2011, 6(13): 88-89.
16.	徐云钦, 李强, 申屠刚, 等. 三种手术方法在肩关节脱位合并肱骨大结节撕脱骨折中的应用. 中国骨与关节损伤杂志, 2012, 27(3): 203-205.
17.	高述玲, 林治建, 丛培军, 等. 解剖锁定钢板内固定治疗肱骨大结节骨折. 中国骨与关节损伤杂志, 2012, 27(1): 90-91.
18.	沈福祥. 肱骨大结节骨折 67 例治疗分析. 中国现代医生, 2011, 49(7): 112-113.
19.	王永. 多根缝线张力带缝合固定术治疗粉碎性肱骨大结节骨折疗效观察. 山东医药, 2014, 54(46): 72-73.
20.	赵晨, 商培洋, 车凌宾, 等. 锁定钢板治疗老年肱骨近端骨折合并肩袖撕裂的疗效分析. 中华老年骨科与康复电子杂志, 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. 合并大结节骨折的肩关节脱位的治疗进展. 实用骨科杂志, 2012, 18(11): 997-1000.
2. 党育, 付中国, 芦浩, 等. 关节镜治疗肩关节脱位合并肱骨大结节骨折近期疗效. 中国修复重建外科杂志, 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, 罗斌, 赵猛, 等. anchor 结合 krackow 缝合法在肱骨大结节骨折及肩袖损伤中应用的疗效观察. 中华临床医师杂志: 电子版, 2012, 6(13): 3793-3794.
5. 王亨火, 张福强, 林进椂, 等. 难复性肱骨大结节撕脱先骨折伴肩关节脱位的手术治疗初步分析. 中国医学创新, 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. 俞银贤, 朱力波, 马金忠, 等. 创伤性肩关节后脱位的诊断与治疗. 中华关节外科杂志: 电子版, 2012, 6(1): 23-28.
8. 曹烈虎, 翁蔚宗, 宋绍军, 等. 微创空心钉与切开复位钢板内固定治疗肱骨大结节骨的疗效比较. 中国修复重建外科杂志, 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, 肖海军, 石伟哲, 等. 手术治疗老年陈旧性肩关节脱位的疗效观察. 中国修复重建外科杂志, 2015, 29(9): 1076-1079.
13. 温辉林, 万乃明, 胡利典, 等. 新鲜难复性肩关节脱位 1 例报告. 骨科, 2012, 3(1): 54.
14. 陈优民, 黄际河, 李群, 等. 可吸收螺钉结合可吸收线张力带内固定治疗肱骨大结节骨折. 临床骨科杂志, 2012, 15(1): 20.
15. 曲振明. 空心钉内固定治疗肩关节脱位合并大结节骨折. 中国实用医药, 2011, 6(13): 88-89.
16. 徐云钦, 李强, 申屠刚, 等. 三种手术方法在肩关节脱位合并肱骨大结节撕脱骨折中的应用. 中国骨与关节损伤杂志, 2012, 27(3): 203-205.
17. 高述玲, 林治建, 丛培军, 等. 解剖锁定钢板内固定治疗肱骨大结节骨折. 中国骨与关节损伤杂志, 2012, 27(1): 90-91.
18. 沈福祥. 肱骨大结节骨折 67 例治疗分析. 中国现代医生, 2011, 49(7): 112-113.
19. 王永. 多根缝线张力带缝合固定术治疗粉碎性肱骨大结节骨折疗效观察. 山东医药, 2014, 54(46): 72-73.
20. 赵晨, 商培洋, 车凌宾, 等. 锁定钢板治疗老年肱骨近端骨折合并肩袖撕裂的疗效分析. 中华老年骨科与康复电子杂志, 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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