整復時に関節か骨折を生じたと思われた肩関節脱臼の１例

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It is extremely uncommon to fail to reduce an acute anterior dislocation of the shoulder by manipulation. This report was on such a rare case of irreducible acute anterior dislocation of the shoulder owing to an interposed fragment of the anterior glenoid rim. A 68-year-old woman dislocated her right shoulder when she fell over. The shoulder was manipulated under brachial block by using the Hippocratic technique. But it was unsuccessful. In the initial radiographs, there seemed to be a common anterior dislocation of the shoulder. After reducing it, the radiographs showed an interposed fragment of the anterior glenoid rim. The computed tomographs showed an "L-shaped" defect of the anterior glenoid rim. Closed reduction was abandoned and an operation was performed. The fragment was inside out. The glenoid labrum was attached to it. Furthermore nearly 30% of the articular cartilage of the glenoid was attached to the fragment. It was assumed that a fracture of the anterior glenoid rim had occurred at the time of reduction. The fragment was easily reduced and fixed with absorbable screws. Eleven months after the surgery, the shoulder was stable with slight restriction of the range of motion. This could be one of the extremely rare cases of irreducible acute anterior dislocation of the shoulder.