Department of Orthopedics, Luotian County People's Hospital, Luotian, 438600, Hubei, People's Republic of China.
Department of Orthopedics, The Central Hospital of Enshi Autonomous Prefecture, Enshi Clinical College of Wuhan University, Enshi, 445000, Hubei, People's Republic of China.
Eur J Med Res. 2021 Jul 12;26(1):73. doi: 10.1186/s40001-021-00545-3.
Shoulder dislocation and the cases of iatrogenic fractures during manual reduction are becoming increasingly common. The aim of this study was to investigate the characteristics, management, and patient outcomes of iatrogenic proximal humeral fracture during the manual reduction of shoulder dislocation.
A retrospective and multi-center study was performed to identify all patients presenting with shoulder dislocation from January 2010 to January 2020. The sex and age of patients, associated injuries, first-time or habitual shoulder dislocation, type of anesthesia, time from injury to revision surgery, and functional outcomes were analyzed.
A total of 359 patients with a mean age of 62.1 ± 7.3 years (range 29-86 years) were included. Twenty-one patients (female/male ratio 17:4) with an average age of 66.3 ± 9.7 years (range 48-86 years) were identified with a post-reduction iatrogenic fracture. Female cases with greater tuberosity fractures (GTF) were more likely than male cases to have iatrogenic fractures during reduction (P = 0.035). Women aged 60 years or older experienced more iatrogenic fractures during manual reduction (P = 0.026). Closed reduction under conscious sedation was more likely than that under general anesthesia to have iatrogenic fractures (P = 0.000). A total of 21 patients underwent open reduction and internal fixation (ORIF) when iatrogenic fractures occurred. The mean follow-up period was 19.7 ± 6.7 months (range 12-36 months). The mean Neer scores were 80.5 ± 7.6 (range 62-93), and the mean visual analog score (VAS) was 3.3 ± 1.5 (range 1-6). Significant differences were observed in the Neer score and VAS with the time (more or less 8 h) from injury to revision surgery (P < 0.05).
A high risk of iatrogenic proximal humeral fracture is present in shoulder dislocation with GTF in senile females without general anesthesia. ORIF performed in a timely manner may help improve functional outcomes in the case of iatrogenic injury.
肩脱位和手法复位时医源性骨折的发生率越来越高。本研究旨在探讨手法复位治疗肩脱位时医源性肱骨头骨折的特点、处理方法和患者预后。
回顾性多中心研究，纳入 2010 年 1 月至 2020 年 1 月间因肩脱位就诊的所有患者。分析患者的性别和年龄、合并伤、初次或习惯性肩脱位、麻醉类型、受伤至翻修手术的时间以及功能结局。
共纳入 359 例患者，平均年龄 62.1±7.3 岁（29-86 岁）。21 例（女性/男性比例 17:4）患者平均年龄 66.3±9.7 岁（48-86 岁），复位后发生医源性骨折。女性患者中肱骨大结节骨折（GTF）比男性患者更容易发生医源性骨折（P=0.035）。60 岁及以上女性在手法复位时更易发生医源性骨折（P=0.026）。在清醒镇静下闭合复位比全身麻醉下更易发生医源性骨折（P=0.000）。发生医源性骨折后，21 例行切开复位内固定（ORIF）。平均随访 19.7±6.7 个月（12-36 个月）。Neer 评分平均 80.5±7.6（62-93），视觉模拟评分（VAS）平均 3.3±1.5（1-6）。受伤至翻修手术时间（8 小时以内或以外）与 Neer 评分和 VAS 显著相关（P<0.05）。
对于无全身麻醉的老年女性伴 GTF 的肩脱位，医源性肱骨头骨折风险较高。及时行 ORIF 有助于改善医源性损伤的功能结局。
