Sears Benjamin W, Lazarus Mark D
Synergy Orthopaedics, St Anthony’s North Hospital, Westminster, CO 80031-3887, USA.
Orthopedics. 2012 Aug 1;35(8):e1279-82. doi: 10.3928/01477447-20120725-35.
Arthroscopy is commonly used for evaluating intra-articular fracture patterns and assessing postfixation reduction; however, the use of arthroscopy for the definitive treatment of articular fracture nonunion has not been reported. This article describes a case of symptomatic glenoid fossa fracture nonunion that was successfully treated with arthroscopically assisted percutaneous screw fixation and bone grafting. A 48-year-old laborer sustained a glenoid fossa fracture following a fall from a height. An initial period of nonoperative management was attempted; however, the patient reported continued shoulder pain during his rehabilitation course. Imaging 5 months after injury showed no osseous union at the fracture. Using an arthroscopically assisted technique, percutaneous fixation and bone grafting of the nonunion with cancellous allograft was performed. Postoperatively, the patient progressed through a structured therapy program, and his pain improved. A computed tomography scan 4 months postoperatively showed osseous union at the fracture site. To the authors' knowledge, this is the first report in the literature of definitive arthroscopically assisted bone grafting and percutaneous fixation of a diarthrodial joint nonunion. Advantages of arthroscopic fixation of glenoid fossa fracture nonunion include avoiding potential axillary nerve injury and preserving the native subscapularis insertion, which may be important if subsequent procedures require access to the anterior access to the joint.
关节镜检查常用于评估关节内骨折类型和评估内固定复位情况；然而，关节镜检查用于确定性治疗关节骨折不愈合的情况尚未见报道。本文描述了一例有症状的肩胛盂骨折不愈合病例，该病例通过关节镜辅助下经皮螺钉固定和植骨成功治愈。一名48岁的劳动者从高处坠落导致肩胛盂骨折。起初尝试了一段时间的非手术治疗；然而，患者在康复过程中仍诉说肩部持续疼痛。受伤5个月后的影像学检查显示骨折处无骨愈合。采用关节镜辅助技术，对骨折不愈合处进行经皮固定并用松质骨同种异体骨植骨。术后，患者通过结构化治疗方案取得进展，疼痛得到改善。术后4个月的计算机断层扫描显示骨折部位骨愈合。据作者所知，这是文献中首次报道关节镜辅助下确定性植骨和经皮固定滑膜关节骨折不愈合的病例。关节镜固定肩胛盂骨折不愈合的优点包括避免潜在的腋神经损伤和保留肩胛下肌的天然附着点，如果后续手术需要进入关节前方，这可能很重要。
