Hinov Viktor, Wilson Franklin, Adams Gayl
Sports Medicine Institute of Indiana, Indianapolis, Indiana 46256, USA.
Arthroscopy. 2002 Nov-Dec;18(9):1020-3. doi: 10.1053/jars.2002.36484.
Articles describing the treatment of proximal humerus malunion are limited. Although in most of the cases, shoulder arthroplasty is the treatment of choice, when the articular surface of the humeral head is intact, other techniques can be considered and successfully used as well. Using arthroscopic techniques for proximal humerus malunion treatment is rarely reported in the literature. We could find only a few cases in which arthroscopic subacromial decompression was used to treat greater tuberosity malunion. Arthroscopic debridement and capsulotomy are also considered in the treatment of proximal humeral malunion cases with shoulder joint stiffness. This case report describes the completely arthroscopic treatment of a 4-part proximal humeral fracture malunion associated with pain and restricted range of motion. The main deformity in our case was medially displaced malunited lesser tuberosity that was blocking the internal rotation of the humerus. Isolated displaced lesser tuberosity fractures are rare injuries. Open techniques are usually the treatment of choice. We did not find any reports of arthroscopic treatment of lesser tuberosity malunion as a separate entity or as a component of a proximal humerus malunion. The early result in our case strongly encourages using arthroscopic techniques for lesser tuberosity malunion treatment as well as expanding the indications for shoulder arthroscopy in proximal humerus malunion cases.
描述肱骨近端畸形愈合治疗的文章有限。尽管在大多数情况下，肩关节置换术是首选治疗方法，但当肱骨头关节面完整时，也可考虑并成功应用其他技术。文献中很少报道使用关节镜技术治疗肱骨近端畸形愈合。我们仅能找到少数几例使用关节镜下肩峰下减压治疗大结节畸形愈合的病例。对于伴有肩关节僵硬的肱骨近端畸形愈合病例，关节镜下清创和关节囊切开术也被纳入治疗方案。本病例报告描述了对一例伴有疼痛和活动范围受限的四部分肱骨近端骨折畸形愈合进行完全关节镜治疗的过程。我们病例中的主要畸形是内侧移位的小结节畸形愈合，它阻碍了肱骨的内旋。孤立的移位小结节骨折是罕见的损伤。开放技术通常是首选治疗方法。我们未找到任何关于将关节镜治疗小结节畸形愈合作为一个独立实体或作为肱骨近端畸形愈合一部分的报道。我们病例的早期结果强烈鼓励将关节镜技术用于治疗小结节畸形愈合，并扩大肩关节镜在肱骨近端畸形愈合病例中的应用指征。
