[논문]Displaced Scapula Fracture (Ideberg Type IIb) Combined with a Large Rotator Cuff Tear in Anterior Shoulder Dislocation: A Case Report

Noh, Young-Min; Kim, Chul-Hong; Lee, Seung-Hyun; Im, Chul-Soon

doi:10.5397/cise.2017.20.3.162

Displaced Scapula Fracture (Ideberg Type IIb) Combined with a Large Rotator Cuff Tear in Anterior Shoulder Dislocation: A Case Report 원문보기

Clinics in shoulder and elbow, v.20 no.3, 2017년, pp.162 - 166

Noh, Young-Min (Department of Orthopedic Surgery, College of Medicine, Dong-A University) , Kim, Chul-Hong (Orthopedic Surgery Center, Metro Hospital) , Lee, Seung-Hyun (Department of Orthopedic Surgery, College of Medicine, Dong-A University) , Im, Chul-Soon (Department of Orthopedic Surgery, College of Medicine, Dong-A University)

Abstract ▼ AI-Helper

Traumatic anterior shoulder dislocation combined with scapular fracture in elderly patients is relatively rare. In this case, a patient visited Emergency Room of Dong-A University Hospital for shoulder pain after falling off a ladder. Radiographs demonstrated anterior shoulder dislocation with displaced Ideberg type IIb scapula (glenoid fossa) fracture combined with a large rotator cuff tear on magnetic resonance imaging. We performed arthroscopic rotator cuff repair, but a large fragment in the inferior glenoid was left untreated. At the 1 year follow-up visit, the pain visual analogue scale of the patient was 2, the American Shoulder and Elbow Society score was 88 and the patient had gained nearly full range of motion without any apprehension.

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문제 정의

Based on our literature review, no previous reports have addressed severely displaced Ideberg type IIb scapular fracture combined with rotator cuff tear in anterior shoulder dislocations. Therefore, this case study was written to report the clinical short term results of an arthroscopic repair of a large rotator cuff tear without surgical fixation of the inferior glenoid fragment in an Ideberg type IIb scapular fracture associated with anterior shoulder dislocation in an elderly patient.

제안 방법

Even though defect of the anteroinferior quadrant glenoid might cause re-dislocation in young and active patients, the fragment in our case primarily involved the inferior portion of the glenoid, which showed relatively less extension of the anterior glenoid; therefore, the authors were not concerned about instability of the GH joint in this patient. Finally, the authors were concerned about postoperative shoulder stiffness after extensive dissection of soft tissue considering his age as well as the risk of neurovascular damage, such as axillary nerve injury during reduction procedure with inevitable massive dissection. We were also concerned about the chronicity of the rotator cuff tear and how to manage the tear in this patient.
In the T1 sagittal series of MRI, mild to moderate muscle atrophy was found with mild fatty infiltration, and the torn tendon edge was smoothly thinned; therefore, these findings indicate the possibility of chronic or acute on chronic rotator cuff tear. However, even if concomitant rotator cuff tear was not acute, the originally existing large rotator cuff tear was considered to be one cause of shoulder dislocation; therefore, we decided to repair the tear. Based on these considerations, we deliberated on surgical fixation of the fracture and decided to repair the rotator cuff tear and leave the inferior fragment.

대상 데이터

A 62-year-old male patient visited Emergency Room of Dong-A University Hospital for right shoulder pain after he fell off a ladder. The shoulder motion was unavailable because of severe pain; however, shoulder pain was absent before the accident.

참고문헌 (10)

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Jones CB, Cornelius JP, Sietsema DL, Ringler JR, Endres TJ. Modified judet approach and minifragment fixation of scapular body and glenoid neck fractures. J Orthop Trauma. 2009; 23(8):558-64.

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Schandelmaier P, Blauth M, Schneider C, Krettek C. Fractures of the glenoid treated by operation. A 5- to 23-year follow-up of 22 cases. J Bone Joint Surg Br. 2002;84(2):173-7.
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Ideberg R. Unusual glenoid fractures: a report on 92 cases. Acta Orthop Scand. 1987;58:191-2.
Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma. 1993;7(2):99-106.

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Jaeger M, Lambert S, Sudkamp NP, et al. The AO Foundation and Orthopaedic Trauma Association (AO/OTA) scapula fracture classification system: focus on glenoid fossa involvement. J Shoulder Elbow Surg. 2013;22(4):512-20.

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Hardegger FH, Simpson LA, Weber BG. The operative treatment of scapular fractures. J Bone Joint Surg Br. 1984;66(5): 725-31.

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Itoi E, Lee SB, Berglund LJ, Berge LL, An KN. The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am. 2000;82(1):35-46.

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Displaced Scapula Fracture (Ideberg Type IIb) Combined with a Large Rotator Cuff Tear in Anterior Shoulder Dislocation: A Case Report 원문보기

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Displaced Scapula Fracture (Ideberg Type IIb) Combined with a Large Rotator Cuff Tear in Anterior Shoulder Dislocation: A Case Report 원문보기

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