ABSTRACT
Objective:To evaluate the clinical efficacy of the axillary approach in the treatment of scapular glenoid fracture.Methods:A retrospective analysis was performed of the 12 patients who had been treated for scapular glenoid fracture from November 2019 to April 2021 at Department of Upper Limb Orthopaedics, Zhengzhou Orthopaedic Hospital. They were 4 males and 8 females, aged from 30 to 75 years (mean, 53.5 years). According to the Ideberg classification, there were 2 cases of type Ⅰa, 9 cases of type Ⅱ and one case of type Ⅴa. All cases were treated through the axillary approach. Two patients complicated with anterior shoulder dislocation were treated with manual reduction under anesthesia before operation and the other 10 cases with special plate fixation through the axillary approach. The 3 patients complicated with fracture of greater tuberosity were fixated with a special plate through the lateral shoulder split deltoid approach. Constant-Murley score, visual analogue scale (VAS) and Hawkins grading were used at the last follow-up to evaluate shoulder function, pain and stability after operation.Results:All patients were followed up for 9 to 20 months (mean, 14.4 months). The operation time ranged from 55 to 110 min (mean, 76.3 min), intraoperative bleeding from 60 to 160 mL (mean, 103.8 mL), and hospital stay from 8 to 14 d (mean, 11.1 d). All incisions healed primarily and all scapular glenoid fractures got united 6 months after operation. The last follow-up showed no shoulder instability, neurovascular injury or internal fixation failure. At the last follow-up, the range of motion of the shoulder was 159.2°±26.1° in forward bending, 156.7°±29.6° in abduction, 48.3°± 15.3° in external rotation (neutral position), and 73.3°±12.3° in internal rotation (neutral position), and the Constant-Murley score was (94.0±5.3) points. The range of motion of the shoulder and Constant-Murley score were significantly improved compared with those before operation (10.8°±11.6°, 7.5°±11.4°, 5.8°±10.0°, 42.5°±16.0° and 4.9±4.0, respectively) (all P<0.05). The VAS score was 0 in 11 patients and 2 in one patient at the last follow-up. Conclusion:The axillary approach is feasible for the treatment of scapular glenoid fracture, because it is hidden and less invasive, leading to good clinical outcomes.
ABSTRACT
Objective@#To explore the treatment strategy for traumatic posterior dislocation of shoulder joint with concomitant reverse Hill-Sachs lesion on the humeral head.@*Methods@#Data of 8 consecutive traumatic posterior shoulder dislocations with concomitant compression on anteromedial portion of the affected humeral heads (reverse Hill-Sachs lesion), which resulted from the collision between the posterior rim of the glenoid and anterior portion of the humeral head, who had undergone treatment in our department since July 2015 to June 2018 were retrospectively analyzed. Seven males and 1 female have been included in the case series, with the age between 30-70 years (mean 44.5±12.3 years), 6 on the right shoulder and 2 on the left. 7 were acute injuries and 1 chronic. One patient received closed reduction under brachial plexus block anesthesia, and the rest cases underwent open surgeries. Modified Judet approach was performed in one case due to the concomitant fracture on the postero-inferior glenoid. The other 6 patients received modified delto-pectoral approach. 4 concomitant rotator cuffswere found during the procedures, including1 full thickness tears 3 partial. One patient received McLaughlin surgery, allograft and anchor suture fixation. 2 underwent cannulated screw fixation. Allograft and PHILOS fixation was placed on 4 cases. All 8 patients were required maintaining in mild abduction and external rotation the affected arms, with the protection of the casts. All patients were followed up for 20.6±8.4 months (range, 9-36 months). Constant-Murley scores and visual analogue score (VAS) were used to evaluate the clinical outcomes at the latest follow-up.@*Results@#Infection occurred in 1 case, the humeral head has been resected subsequently and antibiotic cement spacer was inserted for further arthroplasty. Necrosis of the humeral head has been observed in one CT follow up 9 months after surgery, with no limitation of the range of motion of the shoulder. Stage 1 wound closure and bony union were witnessed on the rest 6 patients. No neuromuscular injures or re-dislocations on the affected shoulders was found. The range of motion of the affected shoulder has been recorded at the latest follow-up: 123.8°±30.1° (90°-180°) in flexion, 124.4°±34.2° (80°-180°) in abduction, 36.9°±20.9° (0°-70°) in external (neutral position), 58.8°±10.9° (50°-80°) in internal rotation (neutral position) and 83.5±12.1 (70-95) in Constant-Murley score. Among the 8 patients, 7 patients were at the rank of VAS 0-3, and 1 of 4-6.@*Conclusion@#Optimal treatment options should be chosen based on the humeral head defect status, in case of traumatic posterior shoulder dislocation with concomitant reverse Hill-Sachs lesion. Closed reduction can be tried on < 20% humeral head defect with the help of anesthesia, and surgical option is the optimal one for the defect between 20%-40%.
ABSTRACT
Objective To explore the treatment strategy for traumatic posterior dislocation of shoulder joint with concomitant reverse Hill-Sachs lesion on the humeral head.Methods Data of 8 consecutive traumatic posterior shoulder dislocations with concomitant compression on anteromedial portion of the affected humeral heads (reverse Hill-Sachs lesion),which resulted from the collision between the posterior rim of the glenoid and anterior portion of the humeral head,who had undergone treatment in our department since July 2015 to June 2018 were retrospectively analyzed.Seven males and 1 female have been included in the case series,with the age between 30-70 years (mean 44.5±12.3 years),6 on the right shoulder and 2 on the left.7 were acute injuries and 1 chronic.One patient received closed reduction under brachial plexus block anesthesia,and the rest cases underwent open surgeries.Modified Judet approach was performed in one case due to the concomitant fracture on the postero-inferior glenoid.The other 6 patients received modified delto-pectoral approach.4 concomitant rotator cuffswere found during the procedures,including1 full thickness tears 3 partial.One patient received McLaughlin surgery,allograft and anchor suture fixation.2 underwent cannulated screw fixation.Allograft and PHILOS fixation was placed on 4 cases.All 8 patients were required maintaining in mild abduction and external rotation the affected arms,with the protection of the casts.All patients were followed up for 20.6±8.4 months (range,9-36 months).Constant-Murley scores and visual analogue score (VAS) were used to evaluate the clinical outcomes at the latest follow-up.Results Infection occurred in 1 case,the humeral head has been resected subsequently and antibiotic cement spacer was inserted for further arthroplasty.Necrosis of the humeral head has been observed in one CT follow up 9 months after surgery,with no limitation of the range of motion of the shoulder.Stage 1 wound closure and bony union were witnessed on the rest 6 patients.No neuromuscular injures or re-dislocations on the affected shoulders was found.The range of motion of the affected shoulder has been recorded at the latest follow-up:123.8°±30.1° (90°-180°) in flexion,124.4°±34.2° (80°-180°) in abduction,36.9°±20.9° (0°-70°) in external (neutral position),58.8°± 10.9° (50°-80°) in internal rotation (neutral position) and 83.5±12.1 (70-95) in Constant-Murley score.Among the 8 patients,7 patients were at the rank of VAS 0-3,and 1 of 4-6.Conclusion Optimal treatment options should be chosen based on the humeral head defect status,in case of traumatic posterior shoulder dislocation with concomitant reverse Hill-Sachs lesion.Closed reduction can be tried on ＜ 20％ humeral head defect with the help of anesthesia,and surgical option is the optimal one for the defect between 20％-40％.