Dimakopoulos Panayiotis, Panagopoulos Andreas, Kasimatis George, Syggelos Spiros A, Lambiris Elias
Orthopaedic Clinic, Shoulder and Elbow Surgery Unit, University Hospital of Patras, Greece.
J Orthop Trauma. 2007 Feb;21(2):104-12. doi: 10.1097/BOT.0b013e3180316cda.
To evaluate the radiographic and clinical outcome, including the incidence of recurrence, in patients with displaced greater tuberosity (GT) fractures associated with a traumatic anterior shoulder dislocation.
Retrospective study.
University Hospital (Level 1 trauma center).
There were 34 completely evaluated patients (19 male, 15 female) seen between 1993 and 2002 with a displaced GT fracture associated with a traumatic anterior shoulder dislocation. Average age was 52.8 years and the mean follow-up period was 4.8 years (range, 2.0 to 10 years).
All GT fractures were internally fixed solely with heavy non-absorbable sutures and any associate rotator cuff tear was repaired at the same time. A special rehabilitation protocol was administered in all patients.
Functional assessment was obtained using the parameters of the Constant score which grades outcomes as excellent, very good, good and poor.
Overall, there were 25 (73.5%) excellent, 6 (17.6%) very good, 2 (5.8%) good and 1 (3.1%) poor results, and the average Constant score was 88.4 (range 45.0 to 100.0). All fractures healed radiographically, without evidence of secondary displacement, except in one patient. No case of recurrence of dislocation was noted in any patient. Partial absorption or "lysis" of the GT without significant clinical relevance was detected in 4 cases.
Displaced fractures of the GT after traumatic anterior shoulder dislocation may result in limitation of motion and functional disability if they are not treated promptly by surgery. Open reduction and stable fixation of the GT along with rotator cuff repair when present, allows for early passive motion of the joint, and yields excellent final results in approximately three quarters of the patients and restores their ability to return to full activities of daily living. A compliant patient is also necessary for a successful result.
评估伴有创伤性前肩关节脱位的移位性大结节（GT）骨折患者的影像学和临床结果，包括复发率。
回顾性研究。
大学医院（一级创伤中心）。
1993年至2002年间共34例经全面评估的患者（男19例，女15例），均为伴有创伤性前肩关节脱位的移位性GT骨折。平均年龄52.8岁，平均随访期4.8年（范围2.0至10年）。
所有GT骨折均仅用粗的不可吸收缝线进行内固定，如有合并的肩袖撕裂则同时修复。所有患者均采用特殊的康复方案。
使用Constant评分参数进行功能评估，该评分将结果分为优、良、可、差。
总体而言，结果为优的有25例（73.5%），良的有6例（17.6%），可的有2例（5.8%），差的有1例（3.1%），平均Constant评分为88.4（范围45.0至100.0）。除1例患者外，所有骨折均在影像学上愈合，无二次移位迹象。所有患者均未出现脱位复发情况。4例患者检测到GT有部分吸收或“溶解”，但无明显临床意义。
创伤性前肩关节脱位后的移位性GT骨折若不及时手术治疗，可能导致活动受限和功能残疾。对GT进行切开复位并稳定固定，如有肩袖损伤则同时修复，可使关节早期进行被动活动，约四分之三的患者最终结果优良，并恢复其完全进行日常生活活动的能力。患者配合对取得成功结果也很必要。
