Posterior shoulder dislocation associated with proximal humeral comminuted fracture

Posterior shoulder dislocation associated with proximal humeral comminuted fracture is rare. The posterior dislocation component is usually hidden behind comminuted fracture and not easy to be detected in routine roentgenogram. Comminuted proximal humeral fracture will cause patients to experience too much pain to receive a thorough physical examination, which can make this type of injury more frequently neglected. We present three cases of posterior shoulder dislocation associated with proximal humeral comminuted fracture. The components of the posterior shoulder dislocations were initially neglected, which led to late sequelae in the first case, reoperation in the second case, and a change of operation planning in the third case. Computed tomography is valuable in preoperative planning and detection of posterior dislocation. If it is not available, good patient positioning on the operation table with full access to a fluoroscopic guide is another way to detect posterior dislocation component. Since this type of injury is rare and easily neglected, orthopedic surgeons should have a high clinical suspicion in daily practice so as to avoid misdiagnoses.     

肩关节脱位合并肱骨颈骨折的治疗

目的探讨肩关节脱位合并肱骨颈骨折的治疗方法及疗效。方法从1995年1月至2002年12月对19例肩关节脱位合并肱骨颈骨折患者,行整复、外固定(或尺骨鹰嘴牵引)13例;切开复位内固定6例。结果整复、外固定(或尺骨鹰嘴牵引)13例随访结果,肩关节疗效满意;切开复位内固定6例,5例随访结果肩关节疗效欠佳。结论肩关节脱位合并肱骨颈骨折的治疗,大部分非手术治疗效果满意;手术治疗应重视肩袖损伤和肱骨头坏死的问题。     

Posterior shoulder dislocation associated with acromion fracture

We report a case involving a combination of posterior glenohumeral dislocation and acromion fracture in which the initial treating physician missed the shoulder dislocation. There are only two documented cases with a similar combination of injuries. A correct diagnosis of posterior dislocation is usually delayed due to subtle physical and radiological signs. Associated trivial injuries like acromion fracture may mask more significant injuries, which, if left untreated, may result in significant functional disability. The mechanism of injury, management and outcome in the present case is presented. The utility of CT scan in definitive diagnosis of posterior shoulder dislocation and identification of associated injuries is emphasized.     

肩关节脱位合并肱骨近端隐匿性骨折治疗体会

目的探讨手术治疗肩关节前脱位合并肱骨近端隐匿性骨折的临床疗效。方法对15例肩关节前脱位合并肱骨近端隐匿性骨折患者行手术治疗。结果 15例均获得随访,时间10～23（13.7±4.1）个月。根据Constants评分标准：优4例,良8例,可2例,差1例。未出现并发症。结论肱骨近端隐匿性骨折伴肩关节脱位易漏诊,选择合适的手术方法能有效改善肩关节功能。     

Posterior dislocation of the shoulder associated with fracture of the humeral anatomical neck with 11-year follow-up after early open reduction and internal fixation

BACKGROUND:. The combination of posterior dislocation and fracture of the anatomical neck represents an extremely rare injury. METHODS:. A patient with posterior dislocation of the shoulder and ipsilateral fracture of the humeral anatomical neck was treated with open reduction and internal fixation with two Kirschner wires. He was followed up for 11 years. RESULTS:. The functional results were excellent, and X-ray and MRI investigations revealed the absence of avascular necrosis of the humeral head. CONCLUSION:. Early and accurate open reduction with minimal osteosynthesis resulted in excellent function of the injured shoulder without avascular necrosis.     

Posterior shoulder dislocation with ipsilateral humeral shaft fracture. A case report

A 41-year-old man incurred the unusual combination of subacromial posterior dislocation of the shoulder and ipsilateral humeral shaft fracture. The importance of inspection of joints proximal to long bone fractures cannot be overemphasized. The transscapular view is easily adapted to the diagnosis of this injury. When recognized early, closed reduction is the preferred treatment; open reduction, as in the present case, is reserved for chronic dislocation.     

闭合复位治疗肩关节前脱位合并肱骨颈骨折

闭合复位治疗肩关节前脱位合并肱骨颈骨折广州市中医医院（５１０１３０）钟正仁作者自１９７９年至今治疗１０例肩关节前脱位合并肱骨颈骨折，８例闭合复位获得成功。现报告如下。临床资料１０例中男４例，女６例；年龄１３～６４岁；喙突下脱位３例，盂下脱位５例，锁骨...     

肱骨骨折伴同侧肩关节脱位2例

单纯肱骨骨折或单纯肩关节脱位临床上常见 ,但肱骨骨折同时伴有同侧肩关节脱位则极少见。 1997年 5月～ 1999年 3月我科共收治 2例 ,报道如下。1　临床资料例 1,男 ,43岁 ,右上肢被机械绞伤后 1ｈ入院。查体 :右上臂中段畸形、肿胀 ,可扪及骨擦感 ,皮肤有擦痕 ,Ｘ线片示右肱骨中段横形骨折。拟行切开复位内固定术 ,术前行手法复位、小夹板临时固定 ,在牵拉过程中 ,右上臂肌肉极度松驰。急诊行切开复位钢板螺钉内固定术 ,术毕在手术台上发现右肩呈方肩畸形 ,杜格斯征 (+) ,摄右肩关节Ｘ线片证实右肩关节脱位 ,再行静脉麻醉 ,手法复位成功。例…     

近端锁定钢板治疗肱骨外科颈骨折合并肩关节脱位

目的探讨近端锁定钢板治疗肱骨外科颈骨折合并肩关节脱位的疗效。方法对13例肱骨外科颈骨折合并肩关节脱位患者行切开复位近端锁定钢板内固定。结果 13例均获随访,随访时间12～24个月。无感染、创口不愈合、骨折移位、内固定物松动和切割。术后4个月X线检查骨折均临床愈合。按照Constant评分方法:优11例,可1例,差1例。结论应用解剖锁定钢板治疗肱骨外科颈骨折合并肩关节脱位,临床效果较好。     

Posterior dislocation of the shoulder with ipsilateral humeral shaft fracture: A case report and review of literature

Isolated posterior dislocation of the shoulder with ipsilateral humeral shaft fracture is a rare combination. Three cases of such co-existence have been reported so far. We report a fourth case and review the literature. Our aim is to highlight the importance of this rare co-existence. A high index of suspicion is necessary to diagnose posterior dislocation of the shoulder as most concentration is on the humeral shaft fracture. Delayed diagnosis has a poorer prognosis.     

肩关节后脱位并肱骨解剖颈骨折1例

患者,男,48岁,因摩托车车祸致右肩部损伤。伤后右肩部疼痛、肿胀,活动障碍8h,于2004年3月15日入院。入院后查:右上肢呈中立内旋位,右手掌小鱼迹肌处及右肘后鹰嘴处可见小块皮肤擦伤痕,经X线片及右肩部CT检查,诊断为右肩关节后脱位并解剖颈骨折、肱骨头分离。次日在臂丛麻醉下,行右肩关节切开复位,术中见肱骨解剖颈骨折,整个肱骨头冲出肩关节后方关节囊,嵌顿在肩胛盂的后缘及冈下肌中,与骨折远端分离并呈90°角相交。术中切开后方关节囊的破口,游离出肱骨头,复位解剖颈骨折,用2枚可吸收螺钉交叉固定,术后摄X线片复查,肩关节后脱位矫正,肱骨…     

Posterior fracture dislocation of the shoulder with biceps tendon interposition

Posterior dislocation of the shoulder, a rare injury, results from direct trauma, indirect trauma, or via a seizure or electrical shock. We present a case with a posterior fracture dislocation of the shoulder secondary to a seizure in which interposition of the biceps tendon precluded closed reduction. The fractured lesser tuberosity fragment included the bicipital groove, allowing the biceps tendon to sublux posteriorly preventing closed reduction, thus requiring a subsequent open reduction.     

Shoulder dislocation associated with humeral fracture on the same side (unstable shoulder joint)

The joint instability observed at the dislocation of the shoulder and the humeral fracture on the same side are described. The idea of "unstable shoulder joint" is used and the operative indication of the shoulder dislocation is outlined.     

Posterior dislocation of the hip with ipsilateral displaced femoral neck fracture

Traumatic posterior dislocation of hip associated with ipsilateral displaced femoral neck fracture is a rare injury. Moreover, the management of such patients evokes strong views regarding primary replacement or preserving the femoral head. We presented a case of young adult with such an injury. He was operated upon with reduction of the dislocation and fixation of femoral neck fracture with the help of cancellous screws. Two years later, the fracture had united and the patient was asymptomatic. We further proposed the mechanism of injury for such a fracture and discussed the management in the changing trauma scenario of the developing world.     

Posterior dislocation of the shoulder associated with obstetric brachial plexus palsy

Four cases of posterior dislocation of the shoulder at birth in association with obstetric brachial plexus palsy are presented. Review of the literature suggests that this association is not generally recognised. All cases were diagnosed late; two were treated by open reduction, one by humeral osteotomy and one managed conservatively.     

髋关节后脱位合并髋臼及股骨颈骨折的手术治疗

1998年1月～2007年12月, 我院共收治髋关节后脱位合并髋臼及股骨颈骨折13例,采用髋关节后外侧切口入路行切开复位内固定治疗,临床效果满意. 1 材料与方法 1.1 病例资料 本组13例,男10例,女3例,年龄27～46岁.车祸伤11例,高处坠落伤2例,均为闭合性损伤.受伤后至就诊时间1～6 d.左侧9例,右侧4例.