Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, China.
Int Orthop. 2019 May;43(5):1215-1222. doi: 10.1007/s00264-018-4022-8. Epub 2018 Jun 15.
Shoulder dislocation with greater tuberosity fractures (GTF) is becoming increasingly common, as is the number of cases of iatrogenic humeral neck fractures (IHNF) during reduction. This study investigated the relationship between size of greater tuberosity fragment and occurrence of IHNF in patients with shoulder dislocation and GTF.
A retrospective study was made to identify all patients presenting with shoulder dislocation with GTF between September 2014 and July 2016. There were 74 patients with an average age of 52.4 years (range 18-84 years) representing 76 cases of shoulder dislocation associated with GTF. Patient age, injury mechanism and location, treatment waiting time, and reduction method were noted. Using conventional anterior-posterior view radiographs, three points were identified as A, B, and C. Distance ratios between AC and AB were calculated, then the resulting ratio was compared to a critical value of 0.4.
More iatrogenic fractures occurred in cases where the AC/AB ratio exceeded 0.4. Most (13) occurred during emergency Hippocratic manual reduction. Only five of 18 iatrogenic fractures (27.78%) occurred during surgery while under traction. Women ran a higher risk of iatrogenic fracture than men (female/male ratio 8:1). On average, women were older than men at the time of fracture (59.75 years for women vs. 42 years for men).
A statistically significant relationship exists between size of greater tuberosity fragment and occurrence of iatrogenic humeral neck fractures during the reduction of shoulder dislocation. The larger the greater tuberosity fragment, the higher the incidence of iatrogenic humeral neck fractures. For such fracture dislocations, we recommend open reduction with internal fixation directly and using a Kirschner wire in advance to reinforce the proximal humerus before reduction of the shoulder.
肩盂前脱位伴大结节骨折（GTF）的发生率越来越高，复位过程中发生医源性肱骨干骨折（IHNF）的病例也越来越多。本研究旨在探讨肩盂前脱位伴大结节骨折患者中，大结节骨折块大小与 IHNF 发生的关系。
回顾性分析 2014 年 9 月至 2016 年 7 月期间所有肩盂前脱位伴 GTF 的患者。共 74 例患者，平均年龄 52.4 岁（18-84 岁），共 76 例肩盂前脱位伴 GTF。记录患者年龄、损伤机制及部位、治疗等待时间和复位方法。采用常规前后位 X 线片，确定 A、B、C 三点。计算 AC 与 AB 之间的距离比，然后将所得比值与 0.4 的临界值进行比较。
AC/AB 比值大于 0.4 时更易发生医源性骨折。其中 13 例发生在急诊 Hippocratic 手法复位时，只有 5 例（27.78%）发生在牵引下手术时。女性发生医源性骨折的风险高于男性（女性/男性比例为 8:1）。女性骨折时的平均年龄大于男性（女性 59.75 岁，男性 42 岁）。
肩盂前脱位复位过程中大结节骨折块大小与医源性肱骨干骨折的发生有显著的相关性。大结节骨折块越大，医源性肱骨干骨折的发生率越高。对于这种骨折脱位，我们建议直接行切开复位内固定，并在复位前使用克氏针预先加固肱骨头近端。
