Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SU, UK.
Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SU, UK.
Injury. 2021 Mar;52(3):487-492. doi: 10.1016/j.injury.2020.09.062. Epub 2020 Sep 28.
A fracture of the tuberosity is associated with 16% of glenohumeral dislocations. Extension of the fracture into the humeral neck can occur during closed manipulation, leading some to suggest that all such injures should be managed under general anaesthesia in the operating theatre. The purpose of this study was to establish the safety of reduction of glenohumeral dislocations with tuberosity fractures in the emergency department (ED).
We reviewed 188 consecutive glenohumeral dislocations with associated tuberosity fractures identified from a prospective orthopaedic trauma database. Patient demographics, injury details, emergency department management and complications were recorded. The method of reduction, sedation, grade of clinician and outcome were documented.
The mean age was 61 years (range 18-96 years) with 79 males and 109 females. The majority of injuries (146, 78%) occurred after a fall from standing height. Closed reduction under sedation in the ED was successful in 162 (86%) cases. Of the remainder, 22 (11%) failed closed reduction under sedation and subsequently went to theatre and 6 (3%) were deemed not suitable for ED manipulation. At presentation 35 (19%) patients had a nerve injury, of which 29 (90%) resolved spontaneously. Two iatrogenic fractures occurred during close manipulation, one in the ED and the other in the operating theatre. Therefore, the risk of iatrogenic propagation of the fracture into the proximal humerus neck was 0.5% if the reduction was performed in the ED, and 1% over-all. More than two attempted reductions predicted a failed ED reduction (P = 0.001).
Closed reduction of glenohumeral dislocations with associated tuberosity fractures in the ED is safe, with a rate of iatrogenic fracture of 1%. These injuries should be managed by those with appropriate experience only after two adequate radiographic views. In cases where there is ambiguity over the integrity of the humeral neck, reduction should be delayed until multiplanar CT imaging has been obtained.
肩盂骨突骨折占肩盂肱关节脱位的 16%。在闭合复位过程中，骨折可能延伸至肱骨干，这导致一些人建议所有此类损伤都应在手术室全身麻醉下进行处理。本研究旨在确定在急诊科（ED）复位伴有骨突骨折的肩盂肱关节脱位的安全性。
我们从前瞻性骨科创伤数据库中回顾了 188 例连续的伴有骨突骨折的肩盂肱关节脱位患者。记录患者的人口统计学资料、损伤细节、ED 处理和并发症。记录复位方法、镇静、医生级别和结果。
平均年龄为 61 岁（18-96 岁），男性 79 例，女性 109 例。大多数损伤（146 例，78%）发生在从站立高度跌倒后。在 ED 镇静下闭合复位在 162 例（86%）患者中成功。其余 22 例（11%）在镇静下闭合复位失败，随后转至手术室，6 例（3%）认为不适合 ED 操作。就诊时，35 例（19%）患者有神经损伤，其中 29 例（90%）自发缓解。在闭合复位过程中发生了 2 例医源性骨折，其中 1 例发生在 ED，另 1 例发生在手术室。因此，如果在 ED 进行复位，医源性骨折向肱骨干近端延伸的风险为 0.5%，总体风险为 1%。如果尝试复位超过两次，则预示 ED 复位失败（P=0.001）。
ED 闭合复位伴有骨突骨折的肩盂肱关节脱位是安全的，医源性骨折的发生率为 1%。只有在获得适当的影像学检查后，这些损伤才应由具有适当经验的人员进行处理。在肱骨干完整性存在疑问的情况下，应延迟复位，直至获得多平面 CT 成像。
