前医で徒手整復が不成功であった肩関節前方脱臼の検討

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Background: While the initial treatment of anterior shoulder dislocation is closed reduction, the attempt at reduction may be unsuccessful in rare cases. We analyzed the patients who had been referred to our hospital as having "irreducible anterior dislocation of the shoulder" after the failure of attempted reduction. Methods: Twenty-four patients with irreducible anterior shoulder dislocation were referred to us between 2005 and 2011. There were 2 men and 22 women, and the mean age at dislocation was 76.8 years old. We investigated their clinical and radiographic findings and the contents of our treatment. Results: The primary dislocation was seen in 19 cases, and recurrent dislocation in 5 cases. Five cases had chronic dislocation in which more than 3 weeks had elapsed since dislocation. Imaging studies revealed 10 cases of dislocation and 14 cases of fracture-dislocation. Characteristically, deep and large Hill-Sachs lesion was engaged with anterior glenoid rim in 7 out of 10 dislocations, and greater tuberosity fractures were most commonly seen, 12 out of 14 fracture-dislocations. We attempted closed reduction again under anesthesia and fluoroscopic guidance in all but one case in which we immediately operated because of displaced anatomical neck and greater tuberosity fracture. As a result, closed reduction was successfully accomplished in 18 cases and failed in the remaining 5 cases. Surgery was undertaken in 4 out of the 5 cases. Conclusion: Special caution should be paid to anterior shoulder (fracture-)dislocation occurring in elderly women because of its difficulty in closed reduction.
日本肩関節学会の論文

前医で徒手整復が不成功であった肩関節前方脱臼の検討

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