He Tao
Department of Orthopedics, Chengdu Orthopedic Hospital, Chengdu, Sichuan, China.
J Orthop Case Rep. 2025 Sep;15(9):179-184. doi: 10.13107/jocr.2025.v15.i09.6060.
Low-energy traumatic irreducible anterior shoulder dislocations with concomitant greater tuberosity fractures in elderly females are rarely reported. The difficulty in reduction is attributed to the interplay between osseous impaction and soft tissue interposition. Three-dimensional computed tomography (CT) was utilized to delineate this combined obstruction mechanism. An open surgical approach incorporating joystick reduction techniques and preservation of the long head of the biceps tendon was implemented. To our knowledge, no systematic therapeutic protocols have been established for such complex injuries in geriatric patients.
An 83-year-old Chinese female presented with left shoulder pain and restricted mobility after a ground-level fall. Physical examination revealed a squared shoulder deformity, deltoid muscle strength of 2/5, and sensory abnormalities in the axillary nerve territory. Radiographs confirmed anteroinferior humeral dislocation with comminuted greater tuberosity fracture. Closed reduction attempts failed twice. Three-dimensional.
① Hill-Sachs defect engaging the anterior glenoid rim; ② coronally split greater tuberosity fragment interposed in joint space; ③ 25 mm medial displacement of proximal humerus. The deltopectoral approach exposed the long head of biceps tendon traversing humeral head, forming complex interposition. Kirschner wire (K-wire) joystick technique was employed to disimpact osseous blocks. Tension band suturing combined with locking plate fixation was performed. Biceps tendon integrity was completely preserved. The post-operative course was uneventful, with satisfactory functional and radiographic outcomes and no recurrent dislocation during follow-up.
This case demonstrates that three-dimensional CT precisely identifies osseous impaction mechanisms in irreducible anterior shoulder dislocations among elderly patients. Intraoperative K-wire joystick techniques combined with long head of biceps tendon preservation achieve anatomical reduction and stability restoration. This protocol establishes a standardized imaging-surgical framework for geriatric osteoporotic patients with failed closed reduction.
老年女性低能量创伤性不可复位性前肩关节脱位合并大结节骨折的病例鲜有报道。复位困难归因于骨嵌顿与软组织嵌入之间的相互作用。利用三维计算机断层扫描（CT）来描绘这种联合阻碍机制。实施了一种结合操纵杆复位技术并保留肱二头肌长头的开放手术方法。据我们所知，尚未为老年患者的此类复杂损伤制定系统的治疗方案。
一名83岁的中国女性在平地摔倒后出现左肩疼痛和活动受限。体格检查发现方肩畸形、三角肌肌力为2/5以及腋神经分布区域感觉异常。X线片证实肱骨前下脱位合并大结节粉碎性骨折。两次闭合复位尝试均失败。三维CT显示：①累及前关节盂边缘的希尔-萨克斯损伤；②冠状面劈开的大结节碎片嵌入关节间隙；③肱骨近端内侧移位25毫米。经三角肌胸大肌入路暴露穿过肱骨头的肱二头肌长头，形成复杂的嵌入。采用克氏针（K线）操纵杆技术解除骨块嵌顿。进行张力带缝合并结合锁定钢板固定。肱二头肌肌腱完整性得以完全保留。术后过程顺利，功能和影像学结果令人满意，随访期间无复发性脱位。
该病例表明三维CT能精确识别老年患者不可复位性前肩关节脱位中的骨嵌顿机制。术中克氏针操纵杆技术结合肱二头肌长头保留可实现解剖复位和稳定性恢复。该方案为闭合复位失败的老年骨质疏松患者建立了标准化的影像-手术框架。
