Willis Chad B, Ahmadi Shahryar
Orthopedics. 2019 Jul 1;42(4):e395-e398. doi: 10.3928/01477447-20190624-07.
Proximal humerus fractures in elderly patients are a common injury that can often be treated nonoperatively. However, surgery is indicated with some fracture patterns. Arthroplasty is an attractive option with poor bone quality, when there is a low likelihood of success with open reduction and internal fixation, and due to a timely return to function and weight bearing of the extremity in this patient population. A prerequisite for shoulder function for both native and replacement joints is a functional deltoid. Unfortunately, elderly patients with complex fracture patterns can sustain axillary nerve palsies that make management more difficult. The authors present a case of an elderly patient with a complex fracture-dislocation of the proximal humerus with traumatic axillary nerve palsy treated with hemiarthroplasty, followed by radial-to-axillary nerve transfer after the deltoid failed to improve. Congruency of the joint was restored and significant improvement in objective scoring metrics was achieved, making nerve transfer in this clinical scenario a viable option. [Orthopedics. 2019; 42(4):e395-e398.].
老年患者的肱骨近端骨折是一种常见损伤，通常可采用非手术治疗。然而，某些骨折类型需要手术治疗。当骨质质量较差、切开复位内固定成功可能性较低，且考虑到该患者群体肢体功能能及时恢复和负重时，关节置换术是一个有吸引力的选择。对于天然关节和置换关节而言，肩部功能的一个先决条件是三角肌功能正常。不幸的是，具有复杂骨折类型的老年患者可能会发生腋神经麻痹，这使得治疗更加困难。作者报告了一例老年患者，其肱骨近端复杂骨折脱位并伴有创伤性腋神经麻痹，先行半关节置换术治疗，之后在三角肌功能未改善的情况下进行了桡神经至腋神经移位术。关节恢复了一致性，客观评分指标有显著改善，这使得在这种临床情况下进行神经移位术成为一种可行的选择。[《骨科》。2019年；42(4):e395 - e398。]
