Plachel Fabian, Schanda Jakob E, Ortmaier Reinhold, Auffarth Alexander, Resch Herbert, Bogner Robert
Department of Orthopaedics and Traumatology, Paracelsus Medical University Salzburg, Salzburg, Austria; Institute of Tendon and Bone Regeneration, Spinal Cord Injury and Tissue Regeneration Center Salzburg, Paracelsus Medical University Salzburg, Salzburg, Austria.
Department of Trauma Surgery, AUVA Trauma Center Meidling, Vienna, Austria.
J Shoulder Elbow Surg. 2017 Sep;26(9):e278-e285. doi: 10.1016/j.jse.2017.01.022. Epub 2017 Mar 31.
A combined fracture of the glenoid rim, greater tuberosity, and coracoid process after anterior shoulder dislocation is a rare event. Only 1 patient has been reported in the literature.
All patients with a first-time traumatic anterior shoulder dislocation in a level A trauma center were retrospectively reviewed. Among the 2068 patients treated between 1998 and 2013, we identified 6 patients (0.3%; 1 female, 5 male) with "triple dislocation fracture" (anterior shoulder dislocation with concomitant fracture of the glenoid rim, greater tuberosity, and coracoid process). All patients underwent surgery and had computed tomography scans before surgery and the first postoperative day. Mean follow-up time was 59 months. Clinical and radiographic evaluation, Constant-Murley Score, Simple Shoulder Test, and Subjective Shoulder Value were performed at the final follow-up.
Surgery was determined individually according to the radiologic findings, patient's age, and personal demands. Glenoid reconstruction was performed in all 6 patients, greater tuberosity refixation in 4 patients, and coracoid process refixation in 3. Two patients needed revision surgery due to loss of reduction. At the final follow-up, mean abduction was 133°, mean anterior flexion was 138°; the mean Constant-Murley Score was 72 points; the mean Simple Shoulder Test was 9 points; and the mean Subjective Shoulder Value was 72%. No recurrent instability occurred.
A "triple dislocation fracture," especially coracoid process fractures, can easily be overlooked in radiographs. Computed tomography scans are strongly recommended in patients with a first-time traumatic shoulder dislocation. Because recurrent joint instability and secondary arthropathy are serious complications after anterior shoulder dislocation, surgery should be considered and provides satisfying to excellent results.
肩关节前脱位合并关节盂边缘、大结节及喙突骨折是一种罕见的情况。文献中仅报道过1例患者。
对一家A 级创伤中心所有首次创伤性肩关节前脱位的患者进行回顾性研究。在1998年至2013年期间接受治疗的2068例患者中，我们确定了6例（0.3%；1例女性，5例男性）患有“三联脱位骨折”（肩关节前脱位合并关节盂边缘、大结节及喙突骨折）。所有患者均接受了手术，并在术前及术后第一天进行了计算机断层扫描。平均随访时间为59个月。在末次随访时进行了临床和影像学评估、Constant-Murley评分、简易肩关节测试及主观肩关节评分。
根据影像学表现、患者年龄及个人需求个体化确定手术方式。6例患者均进行了关节盂重建，4例患者进行了大结节重新固定，3例患者进行了喙突重新固定。2例患者因复位丢失需要翻修手术。在末次随访时，平均外展角度为133°，平均前屈角度为138°；平均Constant-Murley评分为72分；平均简易肩关节测试评分为9分；平均主观肩关节评分为72%。未发生复发性不稳定。
“三联脱位骨折”，尤其是喙突骨折，在X线片上很容易被忽视。强烈建议首次创伤性肩关节脱位的患者进行计算机断层扫描。由于复发性关节不稳定和继发性关节病是肩关节前脱位后的严重并发症，应考虑手术治疗，手术效果满意至极佳。
