Cotman Steven J, Trinh Thai Q, Vincent Stephen, Backes Jeffrey R
Mount Carmel Medical Center793 West State Street Columbus, Ohio 43222.
Iowa Orthop J. 2017;37:53-55.
Proximal humerus fractures account for approximately 4-6% of all fractures. While the majority of these fractures are treated non-operatively, the amount of fracture displacement, concomitant injuries, and patient factors often result in the need for surgical stabilization. Although concomitant neurovascular injury in the setting of low-energy trauma is rare, injury to the surrounding neurovascular structures have previously been reported.
We report a case of a 79-year-old male who sustained a low energy fall resulting in a two-part fracture dislocation of the proximal humerus with an associated brachial plexopathy and axillary artery laceration. The patient underwent emergent open reduction internal fixation of his fracture in addition to an axillary-brachial artery bypass using a reverse-saphenous vein graft. The current article reports the presentation, management and prognosis of this rare injury.
At 6 months, the patient demonstrated limited active shoulder abduction with no observed motor function at this elbow, wrist or hand. Radiographic follow up demonstrated a reduced glenohumeral joint with evidence avascular necrosis of the humeral head.
Fracture-dislocations of the proximal humerus may be associated with significant neurovascular injury in the setting of low energy trauma. Despite early treatment, the prognosis of patients with this constellation of injuries is guarded.
肱骨近端骨折约占所有骨折的4%-6%。虽然这些骨折大多采用非手术治疗，但骨折移位程度、合并伤以及患者因素常常导致需要进行手术固定。尽管在低能量创伤情况下合并神经血管损伤较为罕见，但此前已有周围神经血管结构损伤的报道。
我们报告一例79岁男性病例，该患者因低能量跌倒导致肱骨近端两部分骨折脱位，并伴有臂丛神经病变和腋动脉撕裂伤。患者除了接受急诊切开复位内固定治疗骨折外，还使用逆行大隐静脉移植进行了腋-肱动脉搭桥手术。本文报道了这种罕见损伤的临床表现、治疗及预后情况。
6个月时，患者肩关节主动外展受限，肘部、腕部或手部未观察到运动功能。影像学随访显示盂肱关节复位，有肱骨头缺血性坏死的迹象。
肱骨近端骨折脱位在低能量创伤情况下可能伴有严重的神经血管损伤。尽管进行了早期治疗，但患有这种复合型损伤的患者预后仍不容乐观。
