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Intra-articular Lesions and Clinical Outcomes in Traumatic Anterior Shoulder Dislocation Associated with Greater Tuberosity Fracture of the Humerus 원문보기

Clinics in shoulder and elbow, v.20 no.4, 2017년, pp.195 - 200  

Lim, Kuk Pil (Department of Orthopedic Surgery, Busan Bumin Hospital) ,  Lee, In Seung (Department of Orthopedic Surgery, Busan Bumin Hospital) ,  Kim, In-Bo (Department of Orthopedic Surgery, Busan Bumin Hospital)

Abstract ▼ AI-Helper 아이콘AI-Helper

Background: This study investigated and evaluated the clinical outcomes of intra-articular lesions of traumatic anterior shoulder dislocation (TASD) associated with greater tuberosity (GT) fracture of the humerus. Methods: Subjects included 20 patients who were surgically or non-surgically treated f...

주제어

#Intra-articular lesions   #Traumatic anterior shoulder dislocation   #Greater tuberosity fracture  

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제안 방법

  • The remaining 8 patients were treated non-surgically using shoulder immobilization with K-sling brace for 2 weeks. After 2 weeks, the patients sequentially underwent passive exercise, active assistive exercise, active exercise and strengthening exercise. In all cases, MRI scan was performed after the dislocated shoulder was reducted, and the presence of accompanying injury lesions was confirmed.
  • 13) In the GT fracture of the humerus with TASD, there are differing opinions regarding the treatment of intra-articular lesions. This study therefore undertook to investigate the intra-articular lesions of TASD associated with GT fracture of the humerus, and evaluate the clinical outcomes after treating the GT fracture alone.

대상 데이터

  • Two or more intra-articular lesions were identified in 6 patients: HAGL and inferior capsular tear (4 patients), HAGL and Bankart lesion (4 patients), and Bankart lesion and inferior capsular tear (1 patient). One patient had three lesions, namely, GAGL, Bankart lesion and inferior capsular tear. Other accompanying lesions were rotator cuff tears (1 complete and 2 partial supraspinatus tear).
  • The intra-articular lesions were identified in 19 patients; these included 7 Bankart lesions (Fig. 1), 15 humeral avulsion of the glenohumeral ligament (HAGL) lesions, 3 glenoid avulsion of the glenohumeral ligament (GAGL) lesions, and 6 inferior capsular tears (Table 1, 3). Two or more intra-articular lesions were identified in 6 patients: HAGL and inferior capsular tear (4 patients), HAGL and Bankart lesion (4 patients), and Bankart lesion and inferior capsular tear (1 patient).

이론/모형

  • At the last follow-up, clinical outcomes were evaluated by the Simple Shoulder Test (SST) and the Western Ontario Shoulder Instability index (WOSI). The SST consists of 12 questions with dichotomous (yes/no) response options.
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참고문헌 (21)

  1. Lind T, Kroner K, Jensen J. The epidemiology of fractures of the proximal humerus. Arch Orthop Trauma Surg. 1989;108(5):285-7. 

    상세보기 crossref

  2. Platzer P, Kutscha-Lissberg F, Lehr S, Vecsei V, Gaebler C. The influence of displacement on shoulder function in patients with minimally displaced fractures of the greater tuberosity. Injury. 2005;36(10):1185-9. 

    상세보기 crossref

  3. Kim DS, Yoon YS, Lee DK, Park HK, Park JH, Shin J. Accompanying lesions and clinical results in the greater tuberosity fracture of the humerus with anterior shoulder dislocation under the age of forty. Clin Shoulder Elbow. 2011;14(1):20-6. 

    원문보기 상세보기 crossref

  4. Neer CS. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970;52(6):1077-89. 

    상세보기 crossref

  5. Mclaughlin HL. Dislocation of the shoulder with tuberosity fracture. Surg Clin North Am. 1963;43(6):1615-20. 

    상세보기 crossref

  6. Bigliani LU, Flatow EL, Pollock RG. Fractures of the proximal humerus. In: Harryman DT, Matsen FA, Rockwood CA, et al, eds. The shoulder: Vol. 1. 2nd ed. Philadelphia (PA): WB Saunders; 1998. 337-90. 

  7. Bono CM, Renard R, Levine RG, Levy AS. Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder. J Bone Joint Surg Br. 2001;83(7):1056-62. 

    crossref

  8. Iannotti J, Sidor M. Malunions of the proximal humerus. In: Warner J, Iannotti J, Gerber C, eds. Complex and revision problems in shoulder surgery. Philadelphia (PA): Lippincott-Raven; 1997. 245-64. 

  9. Craig E. Open reduction and internal fixation of greater tuberosity fractures, malunions and nonunions. In: Craig E, ed. Master techniques in orthopaedic surgery: the shoulder. New York (NY): Raven Press; 1995. 289-307. 

  10. Bigliani L, Flatow E. The shoulder. 3rd ed. Philadelphia (PA): WB Saunders; 1998. 337-89. 

  11. Neviaser JS. Complicated fractures and dislocations about the shoulder joint. J Bone Joint Surg Am. 1962;44(5):984-8. 

    상세보기 crossref

  12. Park TS, Choi IY, Kim YH, Park MR, Shon JH, Kim SI. A new suggestion for the treatment of minimally displaced fractures of the greater tuberosity of the proximal humerus. Bull Hosp Jt Dis. 1997;56(3):171-6. 

  13. Williams GR Jr, Wong KL. Two-part and three-part fractures: open reduction and internal fixation versus closed reduction and percutaneous pinning. Orthop Clin North Am. 2000;31(1):1-21. 

    상세보기 crossref

  14. Lippitt SB, Harryman DT, Matsen FA. A practical tool for evaluation of function: the simple shoulder test. In: Matsen FA, Fu FH, Hawkins RJ, eds. The shoulder: a balance of mobility and stability. Rosemont (IL): American Academy of Orthopaedic Surgery; 1993. 501-18. 

  15. Kirkley A, Griffin S, McLintock H, Ng L. The development and evaluation of a disease-specific quality of life measurement tool for shoulder instability. The Western Ontario Shoulder Instability Index (WOSI). Am J Sports Med. 1998;26(6):764-72. 

    상세보기 crossref

  16. Arciero RA, Wheeler JH, Ryan JB, McBride JT. Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med. 1994;22(5):589-94. 

    상세보기 crossref

  17. Barber FA, Ryu RK, Tauro JC. Should first time anterior shoulder dislocations be surgically stabilized? Arthroscopy. 2003;19(3):305-9. 

    상세보기 crossref

  18. Schai PA, Hintermann B, Koris MJ. Preoperative arthroscopic assessment of fractures about the shoulder. Arthroscopy. 1999;15(8):827-35. 

    상세보기 crossref

  19. Kim YK, Ko KC. Arthroscopic findings in acute shoulder dislocation associated with a fracture of greater tuberosity of the humerus. J Korean Orthop Assoc. 2000;35(3):437-42. 

  20. Bottoni CR, Wilckens JH, DeBerardino TM, et al. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, firsttime shoulder dislocations. Am J Sports Med. 2002;30(4):576-80. 

    crossref

  21. Reeves B. Experiments on the tensile strength of the anterior capsular structures of the shoulder in man. J Bone Joint Surg Br. 1968;50(4):858-65. 

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