外傷性肩関節後方脱臼と後方脱臼骨折の6例

抄録

Traumatic posterior dislocation and fracture-dislocation of the shoulder are rare. It is very difficult, not only to diagnose them, but also to determine the optimal treatment methods. In cases of dislocation, we performe manual reduction and use a sling in neutral position for three weeks. In cases of fracture-dislocation, in principle, we perform either manual reduction or open reduction of dislocation by a posterior approach witiout ORIF of fractures, and begin physical therapy within a week. We conducted this study with the objective of considering the validity of this method.
The subjects of this study w e r e two dislocation cases and four fractuse-dislocation cases. The ages ranged from 23 to 46 years. The causes of injury were a traffic accident in five cases and a skiing accident in one. The fracture-dislocation cases were two 2-part fracture and two 3-part fracture cases. The two dislocation cases were manually reduced within 24 hours. In the fracture-dislocation cases, however, diagnosis of two cases was delayed, so that they underwent open reduction 14 days after the injury. While a case had complications of brachial plexus palsy and a Monteggia fracture had joint contracture, the other cases showed satisfactory recovery without any hindrance to daily life.
There is no established view on the treatment of tra u matic posterior fracture-dislocation. For fresh cases, we attempt traction and/or manual reduction at first. However, for cases in which manual reduction has failed, or cases in which diagnosis was delayed, we reduce the dislocation operatively without ORIF of fracture. Within a week after reduction, pendulum exrcises are started. This method of treatment is advantageous in that it is easy, and produces stable satisfactory results without further destroying the gliding mechanism.