Úvod: Poraněním AC kloubu u zlomenin lopatky se detailně dosud nikdo nezabýval. Cílem této studie je proto popsat pathoanatomii těchto poranění. Metody: V souboru 519 zlomenin lopatky u dospělých pacientů vzniklém v období 2002−2020 jsme identifikovali celkem 20 (3,9 %) případů spojených s AC luxací. Jednalo se o 17 mužů a 3 ženy průměrného věku 49 roků (21−78). U všech pacientů byl proveden rtg snímek ramenního kloubu a následně CT vyšetření včetně 3D rekonstrukcí. Tato obrazová dokumentace umožnila hodnocení typu zlomeniny lopatky a typu poranění AC kloubu. Výsledky: V 15 případech byla AC luxace spojena pouze s jednoduchou zlomeninou lopatky (7x zlomenina báze proc. coracoideus, 4x zlomenina akromia nebo laterální spiny, 2krát zlomenina těla lopatky, 1x zlomenina horního glenoidu a 1x zlomenina dolního glenoidu). V 5 případech se jednalo o vícečetné nebo komplexní zlomeniny lopatky (1x kombinace zlomeniny proc. coracoideus a laterální části spina scapulae, v 1 případě kombinace zlomeniny horního glenoidu a akromia, ve 2 případech komplexní intraartikulární zlomenina a v 1 případě skapulotorakální disociace). Závěr: AC luxace je méně častým poraněním doprovázejícím zlomeniny lopatky. Nejčastěji se vyskytuje u zlomenin proc. coracoideus, akromia/ laterální spiny nebo horního glenoidu. Nebyla zaznamenána u zlomenin krčku lopatky.
Introduction: No detailed study dealing with an injury to the AC joint in combination with scapular fractures has been published to date. The aim of this study is to describe pathoanatomy of these injuries. Methods: In a series of 519 scapular fractures in adult patients from the period of 2002−2020 we identified a total of 20 (3.9%) cases associated with AC dislocation. The group comprised 17 men and 3 women with the mean age of 49 years (range, 21−78). Radiographs of the shoulder joint followed by CT examination, including 3D reconstructions, were performed in all patients. This documentation allowed assessment of the scapular fracture pattern and type of injury to the AC joint. Results: AC dislocation was associated with a simple scapular fracture in 15 cases (7 fractures of the coracoid base, 4 fractures of the acromion or the lateral spine, 2 fractures of the scapular body, 1 fracture of the superior and 1 fracture of the inferior glenoid). In 5 cases AC dislocation accompanied multiple or complex scapular fractures (once a combination of a coracoid fracture and a fracture of the lateral scapular spine, once a combination of a fracture of the superior glenoid and of the acromion, 2 cases of a complex intraarticular fracture and 1 case of scapulothoracic dissociation). Conclusion: AC dislocation is relatively infrequent injury accompanying scapular fractures. It is most commonly associated with fractures of coracoid, acromion/lateral spine or superior glenoid. No case of AC dislocation was recorded in a fracture of the scapular neck.
Almost 70 scapular fractures in children and adolescents, up to the age of 17 years, have been described in detail in the literature since 1839. The diagnosis of these injuries was based on autopsy, radiographs, CT and MRI examinations. The most frequent findings were fractures/epiphyseolyses of the coracoid, followed by fractures of the infraspinous part of the body and avulsion of the inferior angle of the scapular body. Less common were fractures of the acromion. Intra-articular fractures of the glenoid, or separation of an intact glenoid along the line of the anatomical or surgical necks, were reported only sporadically. Scapulothoracic dissociation was also recorded in several cases. The majority of fractures were treated non-operatively; operative treatment was used in glenoid fractures, certain fractures of the coracoid and fractures of the scapular body with intrathoracic penetration. Except for scapulothoracic dissociation, outcomes of treatment of these injuries were very good.
- MeSH
- Acromion MeSH
- Child MeSH
- Fractures, Bone * diagnostic imaging surgery MeSH
- Shoulder Fractures * diagnostic imaging MeSH
- Intra-Articular Fractures * MeSH
- Humans MeSH
- Scapula surgery MeSH
- Adolescent MeSH
- Thoracic Injuries * MeSH
- Radiography MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Na prezentovaných kazuistikách popisuje autor vzácnou komplikaci při luxaci a fraktuře proximálního humeru. Obojí s výskytem u nízkoenergetického poranění (prostý pád). V následné diskuzi se pak zabývá možnou etiologií a mechanizmy vzniku poranění a. axillaris a její terapií.
- MeSH
- Angiography methods MeSH
- Angioplasty methods MeSH
- Axillary Artery diagnostic imaging injuries MeSH
- Aspirin therapeutic use MeSH
- Ultrasonography, Doppler, Duplex MeSH
- Shoulder Fractures surgery diagnostic imaging MeSH
- Heparin administration & dosage MeSH
- Humerus diagnostic imaging MeSH
- Conservative Treatment MeSH
- Humans MeSH
- Shoulder Dislocation * diagnosis complications rehabilitation therapy MeSH
- Pentoxifylline therapeutic use MeSH
- Vascular System Injuries * surgery diagnostic imaging drug therapy classification therapy MeSH
- Orthotic Devices MeSH
- Radiography MeSH
- Aged MeSH
- Tomography, Spiral Computed MeSH
- Accidental Falls MeSH
- Closed Fracture Reduction MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
In the presented case reports, the author describes a rare complication in the dislocation and fracture of the proximal humerus. Both with the occurrence of a low-energy injury (simple fall). In the subsequent discussion, he deals with possible aetiology and mechanisms of a. axillaris injuries and its therapies.
- MeSH
- Angiography methods MeSH
- Angioplasty methods MeSH
- Axillary Artery diagnostic imaging injuries MeSH
- Aspirin therapeutic use MeSH
- Ultrasonography, Doppler, Duplex MeSH
- Shoulder Fractures surgery diagnostic imaging MeSH
- Heparin administration & dosage MeSH
- Humerus diagnostic imaging MeSH
- Conservative Treatment MeSH
- Humans MeSH
- Shoulder Dislocation * diagnosis complications rehabilitation therapy MeSH
- Pentoxifylline therapeutic use MeSH
- Vascular System Injuries * surgery diagnostic imaging drug therapy classification therapy MeSH
- Orthotic Devices MeSH
- Radiography MeSH
- Aged MeSH
- Tomography, Spiral Computed MeSH
- Accidental Falls MeSH
- Closed Fracture Reduction MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
BACKGROUND: Intramedullary nailing is already established technique for the treatment of two and three-part fractures of proximal humerus. The aim of the study was to prospectively evaluate the efficacy and functional outcome after treatment of four-part fractures of proximal humerus with Multiloc proximal humeral nail. DESIGN: prospective monocentric cohort study. SETTING: single level 1 traumacenter. MATERIALS AND METHODS: From February 2011 to March 2016, 40 patients with displaced four-part proximal humeral fractures were treated with intramedullary nail inserted through anterolateral approach. Minimum one year follow up completed 35 patients and were involved into the study. RESULTS: After mean follow up period of 25.8 months 29 of 35 fractures healed. Average absolute Constant score in all 35 patients reached 57.7 points, relative side related Constants score 66.8% of contralateral extremity. Together there were 20 complications. in 6 cases (17%) developed complete avascular necrosis of the head. One deep infection was treated by implantation of antibiotic cement discs. Twelve secondary surgeries were performed, mostly for avascular necrosis development. Function and pain were significantly influenced by the quality of fracture reduction (p < 0.05) and development of complete AVN (p = 0.001). Group of 29 patients without AVN reached relative Constant score 73% of contralateral extremity. CONCLUSIONS: Intramedullary nailing can be used as possible fixation technique for the treatment of four-part fractures of proximal humerus. In experienced hands provides nailing osteosynthesis similar results as reconstruction with locking plates. Appropriate reduction of fracture fragments is the key for good functional result. LEVEL OF EVIDENCE: Level 2b - monocentric prospective cohort study.
- MeSH
- Adult MeSH
- Shoulder Fractures diagnostic imaging pathology surgery MeSH
- Fracture Healing physiology MeSH
- Fracture Fixation, Intramedullary methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Osteonecrosis diagnostic imaging pathology MeSH
- Prospective Studies MeSH
- Radiography MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Treatment algorithms of proximal humerus fractures are still controversially discussed. The enthusiasm towards operative treatment after the introduction of locking implants, has not been justified by the functional results in the elderly population. The majority of those fractures in the geriatric patients can be successfully treated conservatively. Thorough clinical and radiological examination for fracture analysis, dynamic stability control with the use of an image intensifier, and meticulous reduction, in addition with the appropriate orthesis for its retention and rehabilitation, are the keys for the successful treatment of the proximal humerus fracture in the elderly patient. The present review reports on the main treatment aspects of proximal humerus fractures in the geriatric population and proposes a treatment algorithm.
- MeSH
- Algorithms MeSH
- Fracture Fixation methods MeSH
- Shoulder Fractures diagnostic imaging surgery MeSH
- Humans MeSH
- Orthotic Devices MeSH
- Aged MeSH
- Radiographic Image Enhancement methods MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
INTRODUCTION: A typical feature of inferior glenoid fractures is a distal fragment separated from the glenoid fossa. In most cases, the inferior glenoid fractures are associated with a fracture of the scapular body. However, there are no detailed studies of inferior glenoid fractures, and only brief mentions can be found in the literature in this respect. MATERIAL AND METHODS: The basic group comprised 42 patients, with the mean age of 48 years, who sustained 42 fractures of the inferior glenoid. In this group, the scapular fracture anatomy was evaluated, based on 3D CT reconstructions. A total of 29 patients operated on were followed up for 12 to 128 months after injury (average, 52 months), three patients were lost to follow up. The results of the operative treatment, including complications, were assessed radiologically and functionally. RESULTS: Fracture anatomy was described from various aspects, i.e., the size of the articular surface carried by the separated glenoid fragment, the existence of multiple articular fragments, the size of the separated glenoid fragment and the extent of injury to the scapular body. All 29 operatively treated fractures radiologically healed within three months. Full and pain-free range of motion was restored in 18 patients; in eight patients it was limited by 20 degrees and in three patients by more than 40 degrees. The mean Constant score was 82. CONCLUSION: Fractures of the inferior glenoid fossa requires CT examination, including 3D CT reconstruction with subtraction of the surrounding bones. Displaced fractures are indicated for operative treatment.
- MeSH
- Adult MeSH
- Shoulder Fractures diagnostic imaging surgery MeSH
- Glenoid Cavity diagnostic imaging injuries surgery MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Tomography, X-Ray Computed methods MeSH
- Retrospective Studies MeSH
- Range of Motion, Articular MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Fracture Fixation, Internal adverse effects methods MeSH
- Imaging, Three-Dimensional methods MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
