Di Giacomo Lorenzo Maria, Marzano Fabrizio, Zaganelli Andrea, Pace Valerio, Petruccelli Rosario, Rinonapoli Giuseppe, Caraffa Auro
Trauma & Orthopaedics Department, "S.M. della Misericordia Hospital", University of Perugia, Piazzale Gambuli 1, 06100 Perugia, Italy.
Trauma Case Rep. 2021 Oct 25;36:100547. doi: 10.1016/j.tcr.2021.100547. eCollection 2021 Dec.
Proximal humeral fracture-dislocation associated with neurovascular injury is rare events, associated with poorer outcomes and higher risk of complications. A multidisciplinary approach including the orthopaedic and vascular department is essential in treating such kind of injury. The goal of the treatment is to restore the vascular supply and stabilize the fracture. Usually the orthopaedic surgical stabilization provides a stable substrate for the vascular repair. We report a case of 70 years old woman who sustained a 4 part proximal humerus fracture-dislocation with vascular injury at the level of the transition of the subclavian into axillary artery. Because of the impending severe limb ischemia, the priority of the treatment was given to vascular surgical intervention with a by-pass procedure. After 14 days a reverse shoulder prosthesis was thought to be the best alternative in the second stage surgery. At 18 months follow-up we achieved good clinical and radiological outcomes. Although a lack of consensus on the priority of treatments, we achieved good result following our proposed algorithm of treatment.
肱骨近端骨折脱位合并神经血管损伤是罕见事件，预后较差且并发症风险较高。包括骨科和血管外科在内的多学科治疗方法对于此类损伤的治疗至关重要。治疗的目标是恢复血供并稳定骨折。通常，骨科手术稳定可为血管修复提供稳定的基础。我们报告一例70岁女性，其发生了四部分肱骨近端骨折脱位，在锁骨下动脉向腋动脉移行处合并血管损伤。由于即将发生严重的肢体缺血，治疗的优先事项是进行血管外科干预并实施搭桥手术。14天后，在二期手术中，认为反肩关节假体是最佳选择。在18个月的随访中，我们取得了良好的临床和影像学结果。尽管对于治疗的优先顺序缺乏共识，但按照我们提出的治疗方案，我们取得了良好的效果。
