Acute irreducible anterior shoulder dislocation due to interposition of the subscapularis muscle and the lesser tuberosity: a case report.

Nazim Sifi, Ahmad Madani, Mahdi Zeghdoud
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引用次数: 0

Abstract

Efforts to reduce an anterior shoulder dislocation can fail due to numerous mechanical obstructions caused by soft tissue interposition (long head of the biceps, rotator cuff muscles, labrum, musculocutaneous nerve) and/or bony elements (displaced fragment of a greater tuberosity or glenoid fracture, bone impaction such as a Hill-Sachs lesion fixed on the glenoid rim, a bony Bankart lesion). Herein, we report the case of a 35-year-old man who sustained an anterior shoulder fracture-dislocation of his left shoulder after a fall. Despite a postreduction radiological examination that appeared misleadingly reassuring, subtle signs of persistent subluxation raised concerns. A computed tomography (CT) scan revealed subscapularis muscle entrapment along with avulsion of its bony insertion from the lesser tuberosity of the humerus, and a comminuted avulsion fracture of the greater tuberosity of the humerus. The patient underwent surgery using a deltopectoral approach. This involved releasing the entrapped subscapularis muscle and fixing the two fractured fragments. The lesser tuberosity was reduced and secured with two cannulated screws, and the comminuted fragment of the greater tuberosity was reattached using transosseous sutures. At 12-month follow-up, the patient achieved a Constant-Murley score of 85 of 100, with limitation in internal rotation at L3 but no signs of instability or new dislocation episode. This case underscores the importance of confirming shoulder reduction on at least two orthogonal views and paying close attention to the patient's feedback about sensation in their shoulder. Additionally, it highlights the utility of CT or magnetic resonance imaging scans if doubt exists about the integrity of the reduction.

肩胛下肌与小结节之间的夹层导致的急性不可恢复性肩关节前脱位:病例报告。
由于软组织(肱二头肌长头、肩袖肌、盂唇、肌皮神经)和/或骨性要素(大结节或盂骨骨折的移位碎片、固定在盂骨缘上的 Hill-Sachs 病变、骨性 Bankart 病变等)造成的众多机械性障碍,减少肩关节前脱位的努力可能会失败。在此,我们报告了一例 35 岁男子的病例,他在一次跌倒后发生了左肩前部骨折-脱位。尽管复位后的放射学检查似乎令人放心,但持续性半脱位的细微迹象还是引起了他的担忧。计算机断层扫描(CT)显示,肩胛下肌卡压,其骨插入部与肱骨小结节撕脱,肱骨大结节粉碎性撕脱骨折。患者接受了胸骨下入路手术。手术包括松解被夹住的肩胛下肌并固定两块骨折碎片。小结节被缩小,并用两枚套管螺钉固定,大结节的粉碎性骨折片用经骨缝合线重新固定。在12个月的随访中,患者的Constant-Murley评分达到85分(满分100分),L3内旋受限,但没有不稳定或新脱位发作的迹象。该病例强调了在至少两个正交切面上确认肩关节复位并密切关注患者对肩部感觉的反馈的重要性。此外,该病例还强调了如果对肩关节复位的完整性存在疑问,CT 或磁共振成像扫描的实用性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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11 weeks
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