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Anatomic healing after non-operative treatment of a large, displaced anterior glenoid rim fracture after primary traumatic anterior shoulder dislocation – a case report

原发性创伤性肩关节前脱位后巨大移位前肩胛盂缘骨折非手术治疗后解剖愈合 1 例

  • 影响因子:2.27
  • DOI:10.1186/s12891-020-03384-1
  • 作者列表:"Lukas Ernstbrunner","Malik Jessen","Karl Wieser
  • 发表时间:2020-06-14
Abstract

Abstract Background Large, displaced anterior glenoid rim fractures after primary traumatic anterior shoulder dislocation are usually managed by surgical stabilization. Although there is little evidence supporting surgical management, it is often preferred over non-operative treatment. This case report describes non-operative management of such large, displaced anterior glenoid rim fracture with CT- and MRI-based documentation of anatomical healing of the fracture fragment, a finding that has not been described previously. Case presentation This case report describes a 49-year-old male, right-hand dominant, carpenter, who had a left-sided primary anterior shoulder dislocation after a fall while skiing. Initial plain radiographs showed a reduced glenohumeral joint with a large, displaced anterior glenoid rim fracture. CT-evaluation showed a centered humeral head, and as per our institutional protocol, non-operative management was initiated. Longitudinal radiographic assessment at 2 weeks, 4.5 months and 12 months showed reduction of the initially severely displaced fracture fragment. MRI- and CT-evaluation after 12 months confirmed anatomical healing of the fragment. At final follow-up, the patient was highly satisfied, although the healing process was complicated by posttraumatic frozen shoulder, which has had almost fully resolved after 12 months. Conclusions Given that the glenohumeral joint is concentrically reduced, large (displaced) anterior glenoid rim fractures after traumatic primary shoulder dislocation can be successfully treated non-operatively, with the potential of anatomical fracture fragment healing. Therefore, it remains subject to conservative treatment at our institution and surgical stabilization is reserved for patients with a decentered humeral head or persistent glenohumeral instability.

摘要

文摘背景原发性创伤性肩关节前脱位后大的、移位的前盂缘骨折通常采用手术稳定治疗。虽然很少有证据支持手术治疗,但它往往比非手术治疗更受欢迎。本病例报告描述了对这种大的、移位的前关节盂缘骨折的非手术治疗,采用基于 CT 和 MRI 的骨折碎片解剖愈合文件,以前没有描述过的发现。病例报告本病例报告描述了一名 49 岁男性,右手占优势,carpenter,滑雪时摔倒后出现左侧原发性肩关节前脱位。最初的平片显示盂肱关节缩小,有一个大的、移位的前关节盂缘骨折。CT 评估显示肱骨头居中,根据我们的机构方案,开始非手术治疗。2 周、 4.5 个月和 12 个月的纵向影像学评估显示最初严重移位的骨折碎片复位。12 个月后的 MRI 和 CT 评估证实了碎片的解剖愈合。在最后的随访中,患者非常满意,尽管创伤后冻结肩的愈合过程很复杂,12 个月后几乎完全消退。结论鉴于盂肱关节同心复位,外伤性原发性肩关节脱位后大 (移位) 前盂缘骨折可非手术治疗成功,具有解剖骨折碎片愈合的潜力。因此,在我们的机构仍然需要保守治疗,对于肱骨头发育不良或持续性盂肱关节不稳的患者保留手术稳定。

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