Tat Jimmy, Sheth Ujash, Nam Diane
Sunnybrook Orthopaedic Upper Limb (SOUL), Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
J Shoulder Elb Arthroplast. 2021 May 31;5:24715492211020694. doi: 10.1177/24715492211020694. eCollection 2021.
Reverse total shoulder arthroplasty (RTSA) procedures are becoming increasingly more common. While the main complications are known, the management of clavicle fractures in patients with an ipsilateral RTSA is not well described. There are three case studies that document clavicular stress fractures following RTSA with an atraumatic etiology, and to our knowledge, no studies have described a traumatic clavicular fracture following RTSA.
We describe the case of a 75-year-old woman with a traumatic clavicle fracture five years after RTSA for rotator cuff tear arthropathy. With minimal pain and subjective symptoms initially, the patient wished to pursue non-operative treatment. However, she eventually developed a painful non-union and pseudoparalysis of the shoulder with serial radiographs demonstrating progressive superior scapular tilting and scapular notching. Subsequent open reduction internal fixation of her clavicle fracture significantly improved her pain and function.
We report a traumatic clavicle fracture in the setting of RTSA that not only failed to heal but also resulted in scapular notching and shoulder pseudoparalysis that was improved with surgical stabilization of the fracture. It is possible that the setting of a semi-constrained RTSA, the resulting biomechanical imbalance may predispose to impaired fracture healing and non-union of the clavicle fracture.
反式全肩关节置换术（RTSA）越来越常见。虽然主要并发症已知，但同侧RTSA患者锁骨骨折的处理方法尚无详尽描述。有三项病例研究记录了RTSA后锁骨应力性骨折，病因均为非创伤性，据我们所知，尚无研究描述RTSA后创伤性锁骨骨折。
我们描述了一名75岁女性的病例，她因肩袖撕裂性关节病接受RTSA五年后发生了创伤性锁骨骨折。最初疼痛和主观症状轻微，患者希望采取非手术治疗。然而，她最终出现了疼痛性骨不连和肩部假性麻痹，系列X线片显示肩胛骨逐渐向上倾斜和肩胛骨切迹。随后对其锁骨骨折进行切开复位内固定，显著改善了她的疼痛和功能。
我们报告了一例RTSA情况下的创伤性锁骨骨折，该骨折不仅未能愈合，还导致了肩胛骨切迹和肩部假性麻痹，通过骨折手术固定得到改善。在半限制型RTSA情况下，由此产生的生物力学失衡可能易导致锁骨骨折愈合受损和骨不连。
