Wieser Karl, Waltenspül Manuel, Ernstbrunner Lukas, Ammann Elias, Nieuwland Arend, Eid Karim, Gerber Christian
Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
Department of Orthopaedics, Kantonsspital Baden, Baden, Switzerland.
JB JS Open Access. 2020 Dec 23;5(4). doi: 10.2106/JBJS.OA.20.00133. eCollection 2020 Oct-Dec.
Primary traumatic anterior shoulder dislocations can be associated with displaced anterior glenoid rim fractures. Nonoperative treatment of such fractures has been shown to have excellent results in a small cohort of patients; as such, we have been treating these fractures nonoperatively, regardless of fragment size and degree of displacement, provided that post-reduction computed tomography scans revealed an anteroposteriorly centered humeral head. The aim of this study was to analyze the medium- to long-term results of nonoperative treatment of displaced anterior glenoid rim fractures, assessing in particular the residual instability and development of osteoarthritis.
In a 2-center study, 30 patients with a mean age of 48 years (range, 29 to 67 years) were evaluated clinically with use of the Subjective Shoulder Value, Constant score, American Shoulder and Elbow Surgeons score, and Western Ontario Shoulder Instability index, as well as radiographically with use of radiographs and computed tomography scans at a mean follow-up of 9 years (range, 5 to 14 years).
Fracture-healing was documented in all patients. Seven patients (23%) had post-fracture onset of osteoarthritis (5 with Samilson grade I and 2 with Samilson grade IV). Of these, 1 patient had recurrent instability that was successfully treated with hemiarthroplasty 9 years after the index injury (relative Constant score, 101%), and was excluded from further analysis. No other patient had a recurrent redislocation, subluxation, or positive apprehension. The other 6 patients with new-onset radiographic osteoarthritis were pain-free (mean Constant score pain scale, 15 points) with good shoulder function (relative Constant score, 84% to 108%). A total of 26 patients (90%) rated their functional outcome as good or very good, and 3 patients (10%) rated it as fair. The mean relative Constant score was 97% (range, 61% to 108%), the mean American Shoulder and Elbow Surgeons score was 92 points (range, 56 to 100 points), and the mean Western Ontario Shoulder Instability index score was 126 points (range, 0 to 660 points). All patients returned to full-time work.
Nonoperative treatment of anterior glenoid rim fractures following primary traumatic anterior shoulder dislocation results in excellent clinical outcomes with a very low rate of residual instability and, thus, treatment failure. Asymptomatic radiographic osteoarthritis occurred in roughly 1 of 4 patients.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
原发性创伤性肩关节前脱位可能伴有移位的关节盂前缘骨折。对于此类骨折，非手术治疗在一小部分患者中已显示出良好效果；因此，只要复位后的计算机断层扫描显示肱骨头在前后位上居中，无论骨折块大小和移位程度如何，我们一直对这些骨折进行非手术治疗。本研究的目的是分析移位的关节盂前缘骨折非手术治疗的中长期结果，特别评估残余不稳定和骨关节炎的发展情况。
在一项双中心研究中，对30例平均年龄为48岁（范围29至67岁）的患者进行了临床评估，使用主观肩关节评分、Constant评分、美国肩肘外科医师评分和西安大略肩关节不稳定指数，同时进行了影像学评估，包括X线片和计算机断层扫描，平均随访9年（范围5至14年）。
所有患者均有骨折愈合记录。7例患者（23%）骨折后出现骨关节炎（5例为Samilson I级，2例为Samilson IV级）。其中，1例患者出现复发性不稳定，在初次受伤9年后行半关节置换术成功治疗（相对Constant评分，101%），并被排除在进一步分析之外。没有其他患者出现复发性再脱位、半脱位或阳性恐惧试验。其他患新发影像学骨关节炎的6例患者无疼痛（平均Constant评分疼痛量表，15分），肩关节功能良好（相对Constant评分，84%至108%）。共有26例患者（90%）将其功能结果评为良好或非常好，3例患者（10%）评为一般。平均相对Constant评分为97%（范围61%至108%），平均美国肩肘外科医师评分为92分（范围56至100分），平均西安大略肩关节不稳定指数评分为126分（范围0至660分）。所有患者均恢复全职工作。
原发性创伤性肩关节前脱位后关节盂前缘骨折的非手术治疗可带来优异的临床结果，残余不稳定率极低，因此治疗失败率也低。约四分之一的患者出现无症状影像学骨关节炎。
治疗性IV级。有关证据水平的完整描述，请参阅作者指南。
