Nelson G, Brown C, Liu R W
Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
Department of Orthopaedics, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
J Child Orthop. 2018 Oct 1;12(5):493-496. doi: 10.1302/1863-2548.12.180075.
Proximal humerus fractures in adults are approached with a high suspicion for potential associated glenohumeral dislocation. Axillary views of the shoulder can be painful and possibly even lead to dynamic angulation of the proximal humerus fracture. The incidence of associated glenohumeral dislocation in the paediatric population is unclear and it would be useful to determine whether children with proximal humerus fracture require specific axillary view imaging to rule out dislocation.
We retrospectively reviewed 220 proximal humerus fractures in 218 total children. Imaging and follow-up clinic notes were reviewed for potential glenohumeral dislocation.
Average patient age was 9.8 years SD 3.8 with 55% of the patients male and a wide variety of mechanisms of injury. None of the 220 fractures evaluated showed radiographic evidence of a shoulder dislocation, and all 218 children had a follow-up appointment at least 21 days after the injury without any clinical concern of a missed shoulder dislocation.
No paediatric patients presenting with proximal humerus fractures had a corresponding glenohumeral joint dislocation in our relatively large series. We recommend obtaining this additional imaging only in cases with higher energy mechanisms, if there is suspicion of subluxation or dislocation on anteroposterior and scapular-Y views or if there is clinical concern.
Level III Diagnostic.
成人近端肱骨骨折常需高度怀疑合并潜在的盂肱关节脱位。肩部腋位片检查可能会引起疼痛，甚至可能导致近端肱骨骨折发生动态成角。小儿人群中合并盂肱关节脱位的发生率尚不清楚，确定肱骨近端骨折患儿是否需要进行特定的腋位片成像以排除脱位将很有帮助。
我们回顾性分析了218例患儿的220例近端肱骨骨折。对影像学资料及随访门诊记录进行了潜在盂肱关节脱位情况的检查。
患者平均年龄为9.8岁，标准差为3.8岁，55%为男性，损伤机制多种多样。在评估的220例骨折中，均未显示出肩关节脱位的影像学证据，所有218例患儿在受伤后至少21天均进行了随访，均未出现漏诊肩关节脱位的临床问题。
在我们相对较大的病例系列中，没有肱骨近端骨折的小儿患者合并相应的盂肱关节脱位。我们建议仅在损伤机制能量较高、前后位及肩胛Y位片怀疑半脱位或脱位或存在临床疑虑的情况下才进行额外的影像学检查。
III级诊断性。
