Assiotis Angelos, Uppal Harpal S, Rumian Adam, Yeoh Clarence
Trauma and Orthopaedics, Lister Hospital, Stevenage, GBR.
Cureus. 2023 Jun 13;15(6):e40358. doi: 10.7759/cureus.40358. eCollection 2023 Jun.
Fractures of the proximal humerus are common injuries with a bimodal age distribution. They usually present in younger patients after high-energy trauma and in elderly patients after lower-energy trauma. Fractures of the proximal humerus are rarely associated with concomitant fractures of the glenoid, and this is a complex injury pattern that indicates the presence of significant instability. Such injuries are usually treated surgically. Even more rarely, patients may present with proximal humerus fractures and fractures of the coracoid process. A male patient presented to our emergency department (ED) after a fall off the loading platform of his heavy goods vehicle (HGV), resulting in a right shoulder injury. During his initial assessment in ED, a computerised tomography (CT) scan demonstrated the presence of a comminuted proximal humerus fracture, a comminuted anterior glenoid wall fracture, and a coracoid process displaced fracture. Surgical fixation of all three fractures was undertaken in the same sitting. This is the first case described in the literature with a combination of the above injuries and serves as a reminder that as trauma complexity and incidence continue to increase, we should maintain a high index of diagnostic suspicion when dealing with such patients. Furthermore, we present our treatment approach for this case and the rationale behind it.
肱骨近端骨折是常见损伤,具有双峰年龄分布。它们通常在年轻患者遭受高能创伤后以及老年患者遭受低能创伤后出现。肱骨近端骨折很少与肩胛盂骨折同时发生,而这种复杂的损伤模式表明存在明显的不稳定。此类损伤通常采用手术治疗。更罕见的是,患者可能同时出现肱骨近端骨折和喙突骨折。一名男性患者从他的重型货车装载平台上跌落后来到我们的急诊科,导致右肩部受伤。在急诊科对他进行初步评估期间,计算机断层扫描(CT)显示存在肱骨近端粉碎性骨折、肩胛盂前壁粉碎性骨折以及喙突移位骨折。在同一次手术中对所有三处骨折进行了手术固定。这是文献中描述的首例上述损伤组合的病例,提醒我们随着创伤复杂性和发生率不断增加,在处理此类患者时应保持高度的诊断怀疑指数。此外,我们展示了针对该病例的治疗方法及其背后的原理。