Solovyova Olga, Shakked Rachel, Tejwani Nirmal C
Hospital for Joint Diseases, NYU Langone Medical Center New York,NY.
Iowa Orthop J. 2017;37:47-52.
The purpose of this study was to determine if there was an association between iatrogenic fractures and closed reduction of shoulder dislocations.
In a retrospective case series, 150 consecutive patients with acute first time shoulder dislocations were evaluated. Patient demographics, direction of dislocation, associated injuries, reduction methods, number of attempts, and type of anesthesia/analgesia were determined. Pre- and post-reduction radiographs and medical record were reviewed to identify the presence of proximal humerus fractures.
There were thirty nine fracture-dislocations (26%) of the proximal humerus. Eight patients (5%) failed reduction on initial attempt. Four of these (3%) were unable to be reduced in the emergency room and were taken to OR for reduction. There was no statistically significant difference in reduction maneuver or type of anesthesia/analgesia used when comparing fracture-dislocations to dislocations only (p<0.05). No new fractures after reduction were identified.
Iatrogenic fractures of the proximal humerus due to reduction of a shoulder dislocation are extremely rare. None were identified in this review of 150 patients. We believe that closed reduction is safe even in the setting of fracture dislocations.
本研究旨在确定医源性骨折与肩关节脱位闭合复位之间是否存在关联。
在一项回顾性病例系列研究中，对150例连续的首次急性肩关节脱位患者进行了评估。确定了患者的人口统计学资料、脱位方向、合并损伤、复位方法、尝试次数以及麻醉/镇痛类型。回顾复位前后的X线片和病历以确定肱骨近端骨折的存在情况。
肱骨近端有39例骨折脱位（26%）。8例患者（5%）首次尝试复位失败。其中4例（3%）在急诊室无法复位，被送往手术室进行复位。将骨折脱位与单纯脱位进行比较时，复位手法或所使用的麻醉/镇痛类型无统计学显著差异（p<0.05）。复位后未发现新的骨折。
因肩关节脱位复位导致的肱骨近端医源性骨折极为罕见。在对150例患者的本次回顾中未发现此类情况。我们认为即使在骨折脱位的情况下，闭合复位也是安全的。
