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 20022020 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, 2178). 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.
- Klíčová slova
- acromioclavicular dislocation, fracture, osteoporosis, pathoanatomy, scapula, scapular,
- MeSH
- dospělí MeSH
- fraktury proximálního humeru * diagnostické zobrazování epidemiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- lopatka * diagnostické zobrazování zranění MeSH
- luxace ramenního kloubu * diagnostické zobrazování patologie MeSH
- mladý dospělý MeSH
- radiografie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY Shoulder instability is often times accompanied by associated injuries caused by the humeral head displacement. These are primarily bone lesions on the head and socket of the glenohumeral joint. The purpose of this study was to evaluate the frequency, morphology and clinical significance of bone lesions in shoulder instabilities in a group of patients operated in our department for glenohumeral instability between 2012 and 2019. MATERIAL AND METHODS The ongoing evaluation included 373 patients with trauma and habitual instability who had undergone surgery in our department in the period from 2012 to 2019. All patients underwent a preoperative 3D CT scan of the shoulder joint. Subsequently, the morphology and clinical significance of individual bone lesions were evaluated based on the older Burkhart s concept of engaging/nonengaging lesions and the newer concept of glenoid track by Yamamoto and Di Giacomo of 2007, 2014 or 2020. RESULTS The frequency of Hill-Sachs lesion was 83.4% (311) in our group of patients. In nearly two thirds (211 cases) also a bone defect on glenoid was detected (59.3%). When comparing the basic types of instabilities, in the TUBS group the Hill-Sachs lesions were present up to twice as often as in the group with AMBRI instability. Clinically significant Hill-Sachs lesions according to the older concept of engaging/ nonengaging lesions of Burkhart were reported in 104 cases (34%). Clinically significant lesions according to the newer concept of Yamamoto and DiGiacomo (the so-called off-track lesions) were observed in 173 cases (55.6%). Classified as critical were the clinically insignificant lesions (the so-called on-track lesions), which by their location were near the glenoid track. These lesions were found in 80 patients. After adding up the significant (off-track) and critical on-track lesions, we arrived at 253 (81.4%) clinically significant lesions based on the updated Yamamoto concept. DISCUSSION The frequency of Hill-Sachs lesions and glenoid defects identified by us is close to the upper limit of the range described in literature (8 to 100%). Based on the recent study by Yamamoto, added to these defects were the so-called peripheral ontrack defects, the clinical significance of which is currently indisputable. The oldest classification into engaging/nonengaging lesions revealed only 34% of the significant lesions, but this concept does not evaluate the glenoid defect. The newer concept by Yamamoto/DiGiacomo resulted in detecting 55.6% of significant Hill-Sachs lesions. The latest modification of the glenoid track of 2020, which includes also the on-track lesions in the critical zone among the significant lesions, in our group of patients classified 81% of lesions as clinically significant. CONCLUSIONS Our study confirmed the very frequent occurrence of clinically significant Hill-Sachs lesions in shoulder instabilities. Therefore, for the sake of successful shoulder stabilisation surgery detailed preoperative planning with 3D CT of the shoulder joint and evaluation of the associated bone lesions are necessary. The highest detection of clinically significant lesions was achieved by the latest modification of the glenoid track concept. Future studies will have to prove the effect of this classification on the result of surgical treatment. Key words: shoulder instability, glenoid track; bone defects, Hill-Sachs lesion; bipolar lesions; 3D CT evaluation.
- MeSH
- Bankartova léze * MeSH
- incidence MeSH
- lidé MeSH
- luxace ramenního kloubu * diagnostické zobrazování epidemiologie MeSH
- nestabilita kloubu * diagnostické zobrazování epidemiologie etiologie MeSH
- počítačová rentgenová tomografie MeSH
- ramenní kloub * diagnostické zobrazování chirurgie MeSH
- rameno MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
A rare case of a middle-third clavicle fracture concurrent with ipsilateral acromioclavicular dislocation in a 46-year-old women who had fallen off her bicycle is presented. The clavicular fracture was managed by locking plate osteosynthesis. The acromioclavicular joint was stabilised by traction osteorrhaphy that was removed at 7 weeks after the procedure. Both the radiographic and clinical outcomes were very good. The epidemiology, aetiology, diagnosis and therapy of this injury are discussed.
- MeSH
- akromioklavikulární kloub diagnostické zobrazování zranění MeSH
- fraktury kostí diagnostické zobrazování chirurgie MeSH
- klíční kost diagnostické zobrazování zranění MeSH
- kostní destičky MeSH
- lidé středního věku MeSH
- lidé MeSH
- luxace ramenního kloubu diagnostické zobrazování chirurgie MeSH
- radiografie MeSH
- trakce MeSH
- úrazy pádem MeSH
- vnitřní fixace fraktury MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
PURPOSE OF THE STUDY: The aim of this prospective study was to report on an open approach to a bony defect of the glenoid associated with anterior shoulder instability, using a modified Latarjet procedure, in elderly patients. MATERIAL: From 2003 to 2005, 11 patients older than 50 years underwent an open Latarjet procedure performed by two senior surgeons. The mean age of the patients was 65 years (range, 51 to 79 years). All of them were available for follow-up examination. There were seven women and four men. The study inclusion criteria were a bony defect of the anterior glenoid confirmed by a CT scan, age over 50 years, and three or more previous dislocations.The mean pre-operative forward elevation was 121.2 degrees+/-16.6 degrees (range, 40 degrees-180 degrees) and external rotation was 43.3 degrees+/-13.1 degrees (range, 5 degrees-80 degrees). The mean number of dis- locations before surgery was 4.8 (range, 3-8). METHODS: The Latarjet operation makes use of a large coracoid bone graft to extend the glenoid articular surface by means of a lengthened bone platform, and a sling effect of the conjoined tendon passing through the subscapularis muscle. The Constant-Murley score was used to evaluate the results. RESULTS: Shoulder stability and function were restored in all 11 patients at a minimum follow-up of 4 years (range, 49-69 months). There was no recurrence of instability. The range of motion was minimally reduced; the mean loss of elevation was 18.8 degrees and the mean loss of external rotation was 4.0 degrees. The mean Constant-Murley score increased from 56.4+/-13.3 points preoperatively to 81.8+/-11.3 points post-operatively (p<0.05). No significant post-operative complications were observed. DISCUSSION: It is necessary to differentiate between the Latarjet procedure and its modification popularised by Helfet as the Bristow or the Bristow-Latarjet operation. The Bristow procedure transfers only the tip of the coracoid, along with the attached con- joined tendon, to the anterior side of the neck. This procedure does not treat the bony defect and provides a mere soft-tis- sue constraint. Only a few reports of the original Latarjet procedure can be found in the international literature. CONCLUSIONS: The open Latarjet reconstruction can successfully restore shoulder stability in joints with a significant bony defect of the glenoid even in elderly patients. It is effective in situations in which soft-tissue reconstruction is not a reasonable option.
- MeSH
- lidé středního věku MeSH
- lidé MeSH
- luxace ramenního kloubu diagnostické zobrazování chirurgie MeSH
- ortopedické výkony metody MeSH
- radiografie MeSH
- recidiva MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
In treatment of comminuted dislocation fractures of the proximal humerus the most serious therapeutic problem still remains the 6th group of Neer's classification, in particular fractures with four fragments and with a completely dislocated and devitalized head. The authors present in a retrospective study an overall comparison of results assembled in 30 patients (and 19 checked patients resp.) who were operated by the technique of anatomical reconstruction (13 and 8 patients resp.) or by the authors own technique of non-anatomical reconstruction (17 and 11 patients resp.), all operated on account of comminuted dislocation fractures of the proximal humerus at the orthopaedic clinics of the First and Third Medical Faculty, Charles University, Prague in 1976-1988. Analysis of the results of the checked patients made the authors draw the following conclusions: 1. Fractures of the proximal end of the humerus is a relative frequent injury, in particular in the elderly. About 20% of these injuries call for surgical treatment. 2. In all non-anatomical reconstructions the mobility is very restricted in particular exorotation, in anatomical reconstructions the restriction is much smaller. 3. In all patients operated by the technique of non-anatomical reconstruction within three years necrobiotic reconstruction of the fragment of the head occurred which is the greater, the larger the fragment of the head which was preserved. 4. The result of the reconstruction depends on the preservation of nurture of the fragment of the head and on selection of an adequate technique of osteosynthesis. 5. In anatomical reconstructions the most frequent complication was loosening of the osteosynthetic material, a varus position of the head and pseudoarthrosis.(ABSTRACT TRUNCATED AT 250 WORDS)
- MeSH
- dospělí MeSH
- fraktury proximálního humeru komplikace diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- luxace ramenního kloubu komplikace diagnostické zobrazování chirurgie MeSH
- pooperační komplikace MeSH
- radiografie MeSH
- retrospektivní studie MeSH
- senioři MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
- MeSH
- chronická nemoc MeSH
- lidé MeSH
- luxace ramenního kloubu diagnóza diagnostické zobrazování chirurgie MeSH
- radiografie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
