著明な骨頭内反転位を呈した上腕骨近位端骨折後偽関節の一例

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A-62-year old woman fell down and received a hard blow on her right shoulder. Pain and restriction of shoulder motion continued for about 18 months in spite of conservative treatment under a diagnosis of humeral surgical neck fracture (2 parts) at a previous hospital. When she consulted us, her range of motion in the right shoulder was restricted to 70 degree flexion and 20 degree external rotation. Radiographs and computed tomography showed proximal humeral pseudoarthrosis with highly varus displacement of humeral head fragment. The varus angle was over 90 degree. A hemiarthroplasty was performed 24 months after the trauma. Greater and lesser tuberosities were separated from the humeral head fragment, and adhesion of rotator cuff was stripped in full to pull out. The stem height establishment was arranged in consideration of muscle balance. After the operation, ultrasonic therapy (LIPUS) was performed at an early stage, and the shoulder was immobilized in the slight abducted position for 6 weeks. For the present, she has no pain, and her range of motion is 120 degree flexion and 30 degree external rotation.