Bartakke Girishchandra D, Mate Gaurav B, Gaware Shreya D, Padmane Sagar R
Department of Orthopaedics, B. J. Government Medical College, Pune, Maharashtra, India.
J Orthop Case Rep. 2023 Aug;13(8):42-46. doi: 10.13107/jocr.2023.v13.i08.3810.
Isolated acromion fractures are rare and in that too, orthopaedicians rarely come across open acromial fractures. Hence literature regarding their management, outcome and any associated complications is obscure. In an extensive search for literature related to our case we found very few articles. We hereby report a case of Gustilo IIIA open acromial fracture with associated supraspinatus, deltoid and capsular injury managed with tension band wiring (TBW) and soft tissue repair with 6 month follow up.
A 21-year-old male was admitted in our hospital for wound of right shoulder with pain and inability to move this arm with a history of direct trauma with sharp object 3 days back. On examination, a wound 15 cm in length on the superior aspect of the right shoulder with its depth extending up to the glenohumeral joint was noted. The glenohumeral joint was exposed with a Gustilo Anderson type IIIA acromion fracture and injury of supraspinatus and capsule with no associated vascular or neurological injury. Wound was thoroughly irrigated and was used to approach the fracture site for repair. Capsule of shoulder was carefully closed with absorbable suture followed by suturing of supraspinatus with non-absorbable suture. Our initial plan to fix the acromial fracture to spinous process of scapula with 2 4 mm cannulated cancellous screw placed orthogonal to fracture site was modified intraoperative due to screw cut out and we went ahead with TBW with 1 screw and 1 Kirschner wire to prevent further fragmentation of the fragment. Wound was healing and healthy. Patient was started on a passive pendular exercises after 4 weeks and active exercises at 6 weeks. Six months postoperatively patient had complete range of shoulder rotation with forward flexion of 80° and abduction possible till 45°. Patient was able to do most of his activities of daily living barring overhead activities.
As there are very limited cases of this sort of injury, this case report will cast a light on management options and outcomes of such injuries. We received fair results in our study with good healing and painless functional shoulder joint. However, long term and multi centric studies are required for further information pertaining to such scenarios.
孤立性肩峰骨折较为罕见，而且骨科医生很少遇到开放性肩峰骨折。因此，关于其治疗、预后及任何相关并发症的文献资料并不明确。在广泛检索与我们的病例相关的文献时，我们发现相关文章极少。我们在此报告一例Gustilo IIIA 型开放性肩峰骨折病例，伴有冈上肌、三角肌和关节囊损伤，采用张力带钢丝固定（TBW）及软组织修复，并进行了6个月的随访。
一名21岁男性因右肩部伤口、疼痛及无法活动该侧手臂入院，3天前有被锐器直接创伤史。检查发现，右肩部上方有一15厘米长的伤口，深度延伸至盂肱关节。可见Gustilo Anderson IIIA 型肩峰骨折，伴冈上肌和关节囊损伤，无相关血管或神经损伤。伤口彻底冲洗后，经此入路到达骨折部位进行修复。用可吸收缝线仔细缝合肩关节囊，随后用不可吸收缝线缝合冈上肌。我们最初计划用2枚4毫米空心松质骨螺钉垂直于骨折部位将肩峰骨折固定于肩胛骨棘突，但术中因螺钉穿出而修改方案，改用1枚螺钉和1根克氏针进行张力带钢丝固定，以防止骨折块进一步碎裂。伤口愈合良好。4周后患者开始进行被动钟摆运动，6周后开始主动运动。术后6个月，患者肩部旋转范围完全恢复，前屈可达80°，外展可达45°。除过头活动外，患者能够进行大部分日常生活活动。
由于此类损伤的病例非常有限，本病例报告将为这类损伤的治疗选择和预后提供参考。我们的研究取得了较好的结果，伤口愈合良好，肩关节功能无痛。然而，需要进行长期和多中心研究以获取更多关于此类情况的信息。
