Chalidis Byron E, Papadopoulos Pericles P, Dimitriou Christos G
Orthopaedic Department of Hippokration General Hospital, Thessaloniki, Greece.
J Med Case Rep. 2008 Aug 5;2:260. doi: 10.1186/1752-1947-2-260.
Posterior shoulder fracture-dislocation is a rare emergency condition with poor prognosis when there is a delay in diagnosis and presence of associated injuries.
We present a case of a neglected four-part fracture-dislocation of the proximal humerus in a 34-year-old Greek woman. Except from the substantially displaced and comminuted tuberosity fractures, an anterolateral defect of approximately 50% of the articular surface was apparent. Open reduction of the humeral head was followed by reconstruction of the proximal humerus with allograft impaction, transfer of lesser tuberosity to the humeral defect and anatomic fixation of the greater tuberosity and humeral neck fractures. At two and a half years postoperatively, the humeral head was revascularised and properly articulated with the glenoid fossa.
The presented case underlines the variability of injury pattern, the potential of missed diagnosis and the need for preserving the humeral head in young patients regardless of the amount of articular surface defect and disruption of soft tissue attachments.
肩关节后脱位骨折是一种罕见的急症，若诊断延误且伴有其他损伤，预后较差。
我们报告一例34岁希腊女性近端肱骨四部分骨折脱位被漏诊的病例。除了明显移位和粉碎的结节骨折外，还可见关节面约50%的前外侧缺损。对肱骨头进行切开复位，随后采用同种异体骨打压植骨重建近端肱骨，将小结节转移至肱骨缺损处，并对大结节和肱骨干骨折进行解剖固定。术后两年半，肱骨头实现血管再通，并与关节盂正确对位。
该病例强调了损伤模式的多样性、漏诊的可能性，以及在年轻患者中无论关节面缺损程度和软组织附着破坏情况如何都需保留肱骨头的必要性。
