Jones Neil, Clough Oliver, Kantak Avadhoot, Patnaik Surendra
Department of Orthopaedics, East Surrey Hospital, Canada Avenue, Redhill, United Kingdom, RH1 5RH, United Kingdom.
J Orthop Case Rep. 2021 Oct;11(10):25-29. doi: 10.13107/jocr.2021.v11.i10.2452.
It is rare to see chronic bilateral anterior fracture-dislocations as a result of seizure, and we present a case of this type and review of the literature. Despite the signs and symptoms of shoulder dislocation being well documented, and X-ray imaging being good at identifying such pathology, there are a few cases in the literature of missed or chronic shoulder dislocation (a shoulder that has been dislocated for more than 3 weeks) but these are extremely rare. Our case represents the first example of chronic bilateral locked anterior fracture-dislocations requiring open reduction and coracoid osteotomy with GT takedown to gain adequate exposure and allow soft tissue release to facilitate joint reduction. No other case has used anchors to achieve GT fixation, and our patient is the youngest published case with such pathology.
A 16-year-old boy presented to the emergency department with reduced range of movements in both shoulders. Six weeks prior he had suffered an epileptic seizure. X-rays confirmed bilateral anterior shoulder dislocations with displaced greater tuberosity (GT) fractures. Staged open reduction was performed in the right and then left shoulder. Coracoid osteotomy with takedown of the malunited GT fracture was needed to assist with gradual soft tissue contracture release and a successful relocation. Latarjet procedure was then performed and the GTs were fixed using rotator cuff anchors. At 6 months post-operation, on the right side, he achieved forward flexion to 150o and abduction to 120o. On the left side, forward flexion was 110o and abduction was 90o. X rays showed satisfactory maintenance of the reduction without signs of avascular necrosis of the humeral head.
Surgical management of this injury in this way is effective and achieves good results in the first 6 months of follow up. A high index of suspicion should be employed for this injury in post-ictal patients with shoulder pain. Early mobilization and effective physiotherapy is essential post-operatively to achieve good short-term range of motion.
因癫痫发作导致慢性双侧前脱位骨折的情况较为罕见，我们在此呈现一例此类病例并进行文献回顾。尽管肩关节脱位的体征和症状已有充分记录，且X线成像擅长识别此类病变，但文献中仍有少数漏诊或慢性肩关节脱位（脱位超过3周的肩关节）的病例，不过这些极为罕见。我们的病例是首例需要切开复位并进行喙突截骨及大结节切除以获得充分显露并实现软组织松解从而便于关节复位的慢性双侧锁定前脱位骨折。此前没有其他病例使用锚钉来实现大结节固定，且我们的患者是已发表的患有此类病变的最年轻病例。
一名16岁男孩因双肩活动范围受限就诊于急诊科。六周前他曾癫痫发作。X线证实双侧肩关节前脱位伴大结节（GT）骨折移位。先对右侧肩关节进行分期切开复位，随后是左侧。需要进行喙突截骨并切除愈合不良的大结节骨折以辅助逐渐松解软组织挛缩并成功复位。然后进行Latarjet手术，使用肩袖锚钉固定大结节。术后6个月，右侧肩关节前屈达150°，外展达120°。左侧肩关节前屈为110°，外展为90°。X线显示复位维持良好，无肱骨头缺血性坏死迹象。
以这种方式对该损伤进行手术治疗是有效的，且在随访的前6个月取得了良好效果。对于发作后出现肩部疼痛的患者，应高度怀疑这种损伤。术后早期活动和有效的物理治疗对于实现良好的短期活动范围至关重要。
