小結節変形治癒により可動域制限を残した valgus impacted fracture の一例

抄録

Valgus impacted fractures of the proximal humerus are often treated conservatively. However, malunion of the tuberosities will lead to impingement of the shoulder joint. We reported on a case of malunion of the lesser tuberosity after valgus impacted fracture which caused limitation of range of motion (ROM). A 64-year-old woman fell (30 months prior to a recent presentation). Radiographs showed a previous valgus impacted fracture of the right proximal humerus. Fracture was healed, but the limitation of ROM remained. CT showed that there was a malunion of the lesser tuberosity, resulting in limitation of adduction. We treated this impingement by corrective osteotomy. The lesser tuberosity with subscapularis muscle was removed from the humeral head with an osteotome. The lesser tuberosity was then fixed in its original position. At 2-year follow-up, she returned to work and demonstrated a significant improvement in ROM. Our patient presented herself with limited ROM due to malunion of the lesser tuberosity, and CT image demonstrated the resulting impingement. Corrective osteotomy proved to be an effective management technique. However, the important issue with this injury was initial management. CT image is a very effective examination tool that assesses whether tuberosity displacement will cause limitation of ROM. The choice of CT scan as an initial management technique is useful for both nonoperative care and internal fixation.