RESUMEN
Objective To explore the clinical features and operative treatment of floating shoulder injuries. Methods The clinical data of 36 patients with floating shoulder injuries that had been admitted to our hospital from June 1999 to June 2005 were retrospectively analyzed. The scapular neck fractures associated with clavicle fractures were in 31 cases and acromioclavicular joint dislocation in 5 cases. All cases were accompanied by associated injuries, in which rib fractures combined hemopneumothorax and/or lung contusion was 88.9%. The mean time from primary injury to the fracture operation was 9.6 days (range, 3 to 43 days). The clavicle fractures or acromioclavicular joint dislocation were dealt with firstly, then scapular neck fractures treated through modified Judet posterior approach. Thirty-three cases received internal fixation with both injuries of scapular neck and clavicle or acromioclavicular joint and 3 cases received internal fixation only in clavicle shaft. Results All fractures had been restored anatomical reduction in the target site. The mean followed up time was 19.7 months (range, 6 to 69 months). According to Constant and Murley's evaluation, the median score of functional results was 93% (mean 81.3%, range from 9% to 100%). Based on Herscovici's evaluation, 25 (69.4%) cases showed excellent results, 6 (16.7) good, 4 (11.1%) fair, and 1 (2.8%) poor. The recurrence of primary hemopneumothorax was found in 1 case, shoulder joint abduction weakness and subacromial space pain in 3 cases, delayed lesion of suprascapular nerve in 1 case, and posttraumatic shoulder joint instability secondary to arthritis in 1 case postoperation. Conclusion The double injuries with scapular neck and their suspensory device of clavicular shaft or acromioclavicular joint in floating shoulder injuries can hardly be corrected and reduced in three dimensional displacement of distal fracture unit without operation. It is an effective way for such unstable injuries to get good results after open reduction and internal fixation in early stage.
RESUMEN
Objective To explore the clinical features and outcomes of defo rm ities correction of old bucket handle and tilt fractures of pelvis. Methods From October 1998 to October 2002, six patients treated with open reduction, osteoto my and internal fixation for old bucket handle and tilt fractures of pelvis were analyzed. There were 3 males and 3 females aging from 18 to 51 years (mean, 27. 5 years). According to Tile’s classification, all fractures were diagnosed as t ype B2 with longitudinal stability and rotational instability, which were caused by traumatic violence of lateral compression, and associated with anterior ring injuries of ipsilateral inferior and superior rami of pubis combined symphysis separation as well as contralateral posterior ring injury of innominate fracture , dislocation of sacraoiliac joint, or sacral fracture. The incidence of associa ted injury was 100% in the patients as injured. The mean interval from the prima ry injury to the operation was an average of 6.5 months ranging from 2 to 15 mon ths. The limb shortening of buckle handle side of pelvis ranged from 2 to 3.5 cm (mean, 2.5 cm), and the rotational deformity of pelvis was more than 30? in al l patients. The tilting proximal fragment of the superior ramus and disrupted sy mphysis projected inferiorly and posteriorly into the perineum. The surgical pro cedures consisted of: 1) osteotomy through the superior pubic ramus malunion in 6 cases to correct anterior ring deformity, and through innominate osteotomy in 3 cases, direct osteotomy of sacral malunion in 1 case , and sacraoiliac fusion in 2 cases to correct the posterior ring deformity; 2) reduction by manipulati on or assisted with instrumentation; 3) fixation with reconstruction plate in 3 , reconstruction plate combined with anterior pelvic frame in 2, and reconstruct ion plate combined with lag screws in 1. Results All the patients were followed up on an average of 15.6 months (range, 3 to 45 months). The limb discrepancy ha d been completely corrected following satisfactory fracture reduction and union. According to Mears’s evaluation, the anatomical reduction of the pelvis was fo und in 5 cases and satisfactory in 1 patient. According to Majeed’s radiography evaluation, 5 patients were classified as excellent, and 1 good. One patient wi th delayed sacral nerve injury recovered without any treatment after operation. Conclusion The combination of osteotomy through anterior and posterior pelvic ri ng to correct the entire deformities in one stage is an useful technique for imp rovement of the affected limb shortening and prevention of the related complicat ions.