上腕骨外科頚骨折を伴った肩関節後方脱臼の1例

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We reported on a rare case of acute posterior shoulder dislocation with humeral surgical neck fracture. The case was a 27 year-old male who fell down in a traffic accident. He had been diagnosed with posterior shoulder dislocation with a humeral neck fracture ( Robinsons Type-3, Neers 3-part fracture, with the composite tuberosity “shield” fragment ). One week after the injury, we performed open reduction for the posterior dislocation of the shoulder using the anterior approach. When we reduced dislocation of the shoulder, the site of surgical neck fracture was minimally displaced and stable. Then we sutured the tuberosity to metaphysis of the proximal humerus. But the fracture site was severely displaced on the 7th day after the operation. 3 weeks after the 1st operation, we reduced and fixed the displaced surgical neck fracture of the humerus with Polarus humeral nails. The patient obtained bony union of the humerus and no osteonecrosis of the humeral head 1 year after the 2nd operation. The postoperative JOA score was 87 points. The postoperative range of motion of the shoulder was 130° in elevation and 45° in extension and 30° in external rotation. In conclusion, the deltopectoral approach was useful as the operation for posterior shoulder dislocation with humeral surgical neck fracture.
2008-06-30