Gunay Cuneyd, Oken Fuad, Yildirim Ahmet Ozgur, Ucaner Ahmet
Ankara Numune Training and Research Hospital, Department of Orthopaedic Surgery and Traumatology, Altindag, Ankara, Turkey.
J Orthop Case Rep. 2014 Apr-Jun;4(2):69-72. doi: 10.13107/jocr.2250-0685.172.
Proximal humeral fractures account for 4% to 5% of all fractures. Complex proximal humeral fractures with displaced three- and four-part fragments, humeral head splits and fracture-dislocations are more difficult to treat. In older patients, because of poor bone quality, hemiarthroplasty is often the indicated treatment.
One such case of a 73-year-old woman is presented here. The patient presented with a four-part fracture of the proximal humerus, with displacement of the humeral head. Hemiarthroplasty was done in the right shoulder. At postoperative 20 days, during physical therapy, the humeral head component of the prosthesis disengaged and a second operation was necessary. A deltopectoral approach was repeated using the previous incision. The humeral stem was seen to be well-fixed into the bone so the humeral head was changed for a new one of the same size. At two years, the dominant right side had active, painless ROM.
The management and two-year follow-up of this case is reported here, which was the first to occur at our institution.
肱骨近端骨折占所有骨折的4%至5%。伴有移位的三部分和四部分骨折块、肱骨头劈裂及骨折脱位的复杂肱骨近端骨折更难治疗。在老年患者中,由于骨质较差,半关节成形术通常是指定的治疗方法。
本文介绍了一名73岁女性的此类病例。该患者表现为肱骨近端四部分骨折,肱骨头移位。在右肩进行了半关节成形术。术后20天,在物理治疗期间,假体的肱骨头组件脱位,需要进行二次手术。使用先前的切口重复采用三角肌胸大肌入路。可见肱骨干牢固固定于骨内,因此更换了相同尺寸的新肱骨头。两年时,优势右侧肩部活动自如且无痛。
本文报告了该病例的治疗及两年随访情况,这是我们机构首次出现此类情况。