鎖骨遠位端骨折保存療法後にインピンジメント徴候を来した1例

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We report on one case that caused impingement syndrome after conservative treatment of distal clavicle fracture. A 42-year-old man hit his right shoulder in a motorcycle accident and he consulted a hospital. He had distal clavicle fracture diagnosed and was treated conservatively because of slight displacement. He obtained bone union after three months rest. However, he consulted us for the continuance of severe pain five months after injury. The front of his shoulder was painful and Hawkins test was positive. A beak-shaped fracture of Neer classification Type III was detected in X-rays. The bottom end of the distal fragment was greatly prominent in the subacromial bursa. We undertook arthroscopic decompression for impingement syndrome by the fragment. We observed on the bursal side from the posterior portal. The fragment caused impingement in shoulder flexion and abduction, but the rotator cuff damage was slight. Also, the acromioclavicular joint was unstable. We resected the prominent fragment with an abrader from the anterolateral portal so that his shoulder doesnt cause impingement in all range of motion. Though he started rehabilitation on the next day, the preoperative pain was relieved. Postoperatively, as compared with preoperation, the flexion angle improved from 90° to 180° and the abduction angle from 80° to 180°. Japanese Orthopaedic Association shoulder score improved from 55 points to 100 points. The factor of the impingement syndrome varies, but it is rare for it to occur after conservative treatment of the distal clavicle fracture. After this, we may consider surgical treatment in similar injuries.

鎖骨遠位端骨折保存療法後にインピンジメント徴候を来した1例

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