Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Accompanying Lesions and Clinical Results in the Greater Tuberosity Fracture of the Humerus with Anterior Shoulder Dislocation Under the Age of Forty

40세 이하에서 견관절 전방 탈구가 동반된 상완골 대결절 골절에서 관절내 병변 및 임상 결과

  • Kim, Doo-Sup (Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Christian Hospital) ;
  • Yoon, Yeo-Seung (Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Christian Hospital) ;
  • Lee, Dong-Kyu (Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Christian Hospital) ;
  • Park, Hyeun-Kook (Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Christian Hospital) ;
  • Park, Jang-Hee (Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Christian Hospital) ;
  • Shin, John (Department of Orthopaedic Surgery, Wonju College of Medicine, Yonsei University, Wonju Christian Hospital)
  • 김두섭 (연세대학교 원주의과대학 기독병원 정형외과) ;
  • 윤여승 (연세대학교 원주의과대학 기독병원 정형외과) ;
  • 이동규 (연세대학교 원주의과대학 기독병원 정형외과) ;
  • 박현국 (연세대학교 원주의과대학 기독병원 정형외과) ;
  • 박장희 (연세대학교 원주의과대학 기독병원 정형외과) ;
  • 신존정헌 (연세대학교 원주의과대학 기독병원 정형외과)
  • Received : 2011.02.28
  • Accepted : 2011.05.30
  • Published : 2011.06.30
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Abstract

Purpose: The purpose of this study is to investigate the accompanying lesions of humerus greater tuberosity fracture with anterior shoulder dislocation and to analyze its clinical results. Materials and Methods: From May 2005 to November 2008, arthroscopy was performed on a total of 30 selected patients who were diagnosed with humerus greater tuberosity fracture with anterior shoulder dislocation and who were also under the age of 40. The preoperative and postoperative Constant and Rowe scores were compared. Results: There was a total of 21 cases of anteroinferior labral lesions: 2 Bankart lesions, 4 bony Bankart lesions, 4 Perthes lesions, 2 free ALPSA lesions, 3 GLAD lesions and 6 capsular tears. For other lesions, 5 rotator cuff partial tears, 3 SLAP lesions and 1 biceps tendon rupture were found. The constant scores were increased from 56.3 to 94.43 points (p=0.034), and the Rowe scores were increased from 52.56 to 91.76 points (p=0.026). Conclusion: For humerus greater tuberosity fracture with anterior shoulder dislocation, the accompanying lesion was identified and the fracture was treated using arthroscopy. Good clinical results and bone union were achieved. According to the secondary arthroscopic findings, all of the Perthes lesion, the free ALPSA lesion, the GLAD lesion and the capsular tear spontaneously healed or they did not progress to extended rupture although arthroscopic suture was not performed. Any postoperative secondary instability was not observed.

목적: 상완골 대결절 골절에서 견관절 탈구가 동반된 경우 동반 병변을 조사하고 임상적 결과를 알아보고자 한다. 대상 및 방법: 2005년 5월부터 2008년 11월까지 견관절 탈구가 동반된 상완골 대결절 골절 환자 중 40세 이하의 30명을 대상으로 관절경을 시행하였다. 동반 병변을 확인한 후 도관나사 고정 또는 봉합나사를 이용하여 고정을 시행하였다. Constant 점수와 Rowe 점수를 조사하였다. 결과: Bankart 병변 2예, 골성 Bankart 병변 4예, Perthes 병변 4예, free ALPSA 병변 2예, GLAD 병변 3예, 관절낭 파열 6예 관찰되었고, 회전근 개 부분 파열 5예 (16.7%), SLAP type I 2예 (6.7%), SLAP type II 병변 1예 (3.3%), 이두장건 파열 1예 (3.3%)가 관찰되었다. Constant 점수는 술 전 평균 56.30${\pm}$11.83점에서 술 후 평균 94.43${\pm}$7.82점으로 증가하였고 (p=0.034), Rowe 점수는 52.56${\pm}$9.96점에서 91.76${\pm}$9.56점으로 증가하였다 (p=0.026). 결론: 견관절 전방 탈구를 동반한 대결절 골절에서 관절경을 이용한 동반 병변 확인과 골절 치료로 우수한 임상 결과와 골유합을 보였다. 2차 관절경 검사상 Perthes 병변, Free ALPSA 병변, GLAD 병변 및 관절낭 파열은 봉합술을 시행하지 않았지만 자연 치유되거나 더이상 손상의 범위가 증가되지 않았고 술 후 이차적인 불안정성을 유발하지 않았다.

Keywords

References

  1. Neer CS, 2nd. Displaced proximal humeral fractures. I. Classification and evaluation. J Bone Joint Surg Am. 1970;52:1077-89.
  2. McLaughlin HL. Dislocation of the shoulder with tuberosity fracture. Surg Clin North Am. 1963;43:1615-20.
  3. Bigliani L, Flatow E. The shoulder. 3rd ed, Philadelphia, WB Saunders: 1998. 337-89.
  4. Park TS, Choi IY, Kim YH, Park MR, Shon JH, Kim SI. A new suggestion for the treatment of minimally displaced fractures of the greater tuberosity of the proximal humerus. Bull Hosp Jt Dis. 1997;56:171-6.
  5. He YH, Zhao JZ, Huangfu XQ, Liu WX, Zhu Y, Yang XG. [arthroscopic treatment of acute greater tuberosity fractures of the humerus]. Zhonghua Yi Xue Za Zhi. 2010;90:1494-6.
  6. Williams GR, Jr., Wong KL. Two-part and three-part fractures: Open reduction and internal fixation versus closed reduction and percutaneous pinning. Orthop Clin North Am. 2000;31:1-21. https://doi.org/10.1016/S0030-5898(05)70124-3
  7. Arciero RA, Wheeler JH, Ryan JB, McBride JT. Arthroscopic bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med. 1994;22:589-94. https://doi.org/10.1177/036354659402200504
  8. Barber FA, Ryu RK, Tauro JC. Should first time anterior shoulder dislocations be surgically stabilized? Arthroscopy. 2003;19:305-9. https://doi.org/10.1053/jars.2003.50085
  9. Kim DS, Yoon YS, Kwon SM. The spectrum of lesions and clinical results of arthroscopic stabilization of acute anterior shoulder instability. Yonsei Med J. 2010;51:421-6. https://doi.org/10.3349/ymj.2010.51.3.421
  10. Kim YK, Ko KC. Arthroscopic findings in acute shoulder dislocation associated with a fracture of greater tuberosity of the humerus. J Korean Orthop Assoc. 2000;35:437-42.
  11. Bottoni CR, Wilckens JH, DeBerardino TM, et al. A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. Am J Sports Med. 2002;30:576-80.
  12. Kim DS, Yoon YS, Yi CH. Prevalence comparison of accompanying lesions between primary and recurrent anterior dislocation in the shoulder. Am J Sports Med. 2010;38:2071-6. https://doi.org/10.1177/0363546510371607
  13. Reeves B. Experiments on the tensile strength of the anterior capsular structures of the shoulder in man. J Bone Joint Surg Br. 1968;50:858-65.