治療に難渋した肩関節前方脱臼に合併した陳旧性上腕骨大結節骨折の2例

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Old cases of displaced greater tuberosity fracture after traumatic shoulder dislocation associated with rotator cuff dysfunction is relatively uncommon, and reports of surgical treatment are also rare. The purpose of this study was to report difficulty of surgical treatment. One of the 2 cases was a 70-years-old female who sustained an anterior dislocation of the shoulder with a tuberosity fracture after falling from stairs. Initially, the patient was treated conservatively after closed reduction. The patient visited our department 4 months after the accident, and presented severe shoulder pain and limited ranges of motion (ROM) as 30° forward elevation and 0° external rotation. Image findings showed displaced bone fragments from the greater tuberosity. Mobilization and reduction were attempted to accomplish reduction of the fragments arthroscopically, however an open reduction and internal fixation was required for repair. Shoulder pain improved at final follow-up of 6 months after the surgery, but ROMs were limited as 55° elevation and 10° external rotation. JOA scores were 20/100 points preoperatively, and 63/100 at final follow-up. The second case was a 68-years-old male who sustained a dislocation of the shoulder and had closed reduction. The neglected displaced fragments of greater tuberosity caused shoulder pain and weakness of rotator cuff muscles suggested by preoperative images. Both of the anterior and posterior approaches were required to approach to the fragments because of difficulties of mobilization. Three months after surgery, at final follow up, active ROMs were limited as 110° for elevation, and -20° for external rotation. JOA scores were 20/100 points preoperatively, and 60/100 at final follow-up. Sufficient mobilization and fixation for the retracted rotator cuff are required to restore shoulder function. The results of the surgical management in old cases of displaced greater tuberosity fracture have been reported to be less favorable than that in acute cases.

治療に難渋した肩関節前方脱臼に合併した陳旧性上腕骨大結節骨折の2例

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