陳旧性肩関節後方脱臼骨折の1例

概要

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A 27 year-old man sustained right shoulder injury in a bicycle accident. The diagnosis at the first hospital visit was fracture of the proximal humerus, and he was immobilized with the arm at his side for four weeks. After the physical therapy, he returned to his previous work at a book store. Limitation of overhead activity and dullness of the shoulder during motion had continued, and he visited our clinic. Physical examination revealed limitation of active range of motion of his right shoulder, with flexion to 80°, abduction to 70°, external rotation to 0°, and internal rotation to the level of the buttock with no neurological deficit. Radiographs and CTs revealed posterior dislocation of the glenohumeral joint with bone defect of the humeral head. The JOA score was 45 points. 5 months after the injury, surgery was performed. With a deltopectoral approach the humeral head was reduced, followed by transfer of the lesser tuberosity onto the bone defect (modified McLaughlins procedure). The shoulder was immobilized in the handshake position for 5 weeks. The passive range of motion exercises were started at 3 weeks after surgery. He returned to his previous work at 6 months after the surgery. 1 year after the surgery, active range of motion had improved with flexion to 140°, abduction to 100°, external rotation to 50°, and internal rotation to the level of the L4 , and the JOA score improved to 83.5 points.
日本肩関節学会の論文
2008-06-30