Hersche O, Gerber C
University of Berne, Fribourg, Switzerland.
J Bone Joint Surg Br. 1994 Jan;76(1):30-3.
We report seven cases in which open or closed reduction of a shoulder dislocation associated with a fracture of the humeral neck led to displacement of the neck fracture. Avascular necrosis of the humeral head developed in all six patients with anatomical neck fractures. All five anterior dislocations also had a fracture of the greater tuberosity and both posterior dislocations had a fracture of the lesser tuberosity. The neck fracture had not initially been recognised in three of the seven cases. In five cases attempted shoulder reduction led to complete displacement of the head segment, which was treated by open reduction and minimal internal fixation. In the other two cases, shoulder reduction caused only mild to moderate displacement which was accepted and the fracture was treated conservatively. We conclude that biplane radiography is essential before reduction of a shoulder dislocation. Neck fractures must always be ruled out, especially where there are tuberosity fractures. In our series, careful closed reduction under general anaesthesia with optimal relaxation and fluoroscopic control did not prevent iatrogenic displacement. Prophylactic stabilisation of the neck fracture should be considered before reduction of such a fracture-dislocation. It may be, however, that the prevention of displacement by prophylactic stabilisation does not always prevent late avascular necrosis; we observed this in one case.
我们报告了7例肱骨头脱位合并肱骨颈骨折，行开放或闭合复位后导致颈骨折移位的病例。6例解剖颈骨折患者均发生了肱骨头缺血性坏死。5例前脱位均合并大结节骨折，2例后脱位均合并小结节骨折。7例中有3例最初未识别出颈骨折。5例尝试肩关节复位导致头段完全移位，行切开复位及微创内固定治疗。另外2例，肩关节复位仅导致轻至中度移位，予以接受并对骨折进行保守治疗。我们得出结论，在肩关节脱位复位前，双平面X线摄影至关重要。必须始终排除颈骨折，尤其是存在结节骨折的情况。在我们的系列病例中，在全身麻醉下充分放松并在透视控制下仔细进行闭合复位，仍未能防止医源性移位。对于此类骨折脱位，在复位前应考虑对颈骨折进行预防性固定。然而，预防性固定防止移位并不总是能预防晚期缺血性坏死；我们在1例中观察到了这种情况。
