肩峰偽関節のため著明な外転筋力低下を生じた Floating shoulder の一例

概要

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Nonunion of the acromion is considered as an indication for surgery because of reducing the abductor muscles. We report a case of nonunion of the acromion and the coracoid process of the scapula with severe muscle weakness.<BR>A 40-year-old man fell down and was admitted to another hospital under the diagnosis of multiple traumas including a left shoulder contusion. Because his left shoulder pain and active ROM were not improved with conservative treatment, he was referred to our hospital five months after the injury. The ROM in left shoulder was 90° of active flexion, 30° of active abduction with lateral shoulder pain. The abduction strength was weakened of MMT grade 3-. Radiograph showed a fracture of the distal end of the clavicle, the coracoid process and the acromion. CT showed no callus formation in the fracture parts of the coracoid process and the acromion.<BR>The surgical treatment was performed six months after the injury. The coracoid process was fixed with a screw, and acromion was fixed using tension band wiring method with autologous bone graft. The LIPUS was performed just after surgery. Bone union was obtained over 1 year after the operation. The ROM was improved to 160° of active flexion, 160° of active abduction, and abduction strength was also improved MMT 4.<BR>In this case, bone healing took more than one year. It is considered to devise fixation methods like plating and any other bone graft techniques.