Treatment experience of proximal humerus degloving fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Wenqing ,  ZHANG Zuojun , LIU Yunlong

Luoyang Orthopedic-Traumatological Hospital, Orthopedic Hospital of Henan Province, Luoyang Henan, 471002, P.R.China;

Corresponding?author：

ZHANG Zuojun, Email: zjjlip@163.com

Keywords：

Proximal humerus degloving fracture; fracture classification; internal fixation

DOI：

10.7507/1002-1892.201804057

Video：

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Objective To summarize a new type of proximal humerus fracture—proximal humerus degloving fracture, and discuss its injury mechanism, classification criteria, and treatment methods. Methods The clinical data of 23 patients with proximal humerus degloving fracture between September 2009 and September 2016 was retrospectively analyzed. There were 14 males and 9 females, with an average age of 39.7 years (range, 21-66 years). The causes of injury was sprain in 2 cases, falling from height in 8 cases, and traffic accident in 13 cases. The time from injury to operation was 3-116 days (mean, 17.1 days). There were 2 cases of posterior dislocation of humeral head, 3 cases of anterior dislocation of humeral head, 3 cases of other fractures, and 2 cases of brachial plexus injury. All patients had varying degrees of rotator cuff injuries. According to the self-determined fracture classification criteria, there were 6 cases of internal rotation type, 14 cases of external rotation type, and 3 cases of abduction type. All patients underwent open reduction and internal fixation. Results All patients were followed up 9-24 months (mean, 17 months). All incisions healed by the first intention. X-ray films showed that all fractures healed at 3-5 months after operation (mean, 3.6 months). According to the Neer’s shoulder functional evaluation criteria at 6 months, the shoulder function was rated as excellent in 16 cases, good in 5 cases, fair in 1 case, and poor in 1 case, and the excellent and good rate was 84.6%. The rotator cuff tear recurred in 1 case and was repaired again. Conclusion The injury mechanism of proximal humerus degloving fracture may be the extreme internal rotation, extreme external rotation, or extreme abduction. Reduction and internal fixation is an effective treatment. The focus of the treatment is not only the fixation of the fracture, but also the repair and reconstruction of the rotator cuff.

Citation： LI Wenqing, ZHANG Zuojun, LIU Yunlong. Treatment experience of proximal humerus degloving fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(12): 1540-1544. doi: 10.7507/1002-1892.201804057 Copy

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5.	Bahrs C, Lingfenfelter E, Fisher F, et al. Mechanism of injury and morphology of the greater tuberosity fracture. J Shoulder Elbow Surg, 2006, 15(2): 140-147.
6.	Ohzono H, Gotoh M, Mitsui Y, et al. Isolated fracture of the lesser tuberosity of the humerus: a case report. Kurume Med J, 2011, 58(4): 131-133.
7.	黃久勤. 肩關節后脫位并肱骨大小結節骨折一例. 中華創傷雜志, 2006, 22(4): 275.
8.	丁實, 賈科鋒, 翟麗東, 等. 結節間溝及其毗鄰結構斷層解剖學研究. 解剖學研究, 2010, 32(6): 401-404.
9.	王海豐, 黃磊, 顧千里. 可吸收螺釘治療肱骨大結節骨折. 現代中西醫結合雜志, 2005, 14(1): 88-89.
10.	Thanasas C, Kontakis G, Angoules A, et al. Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elbow Surg, 2009, 18(6): 837-844.
11.	章偉, 陳云豐, 宋文奇, 等. 三種不同內固定方式對肱骨大結節骨折穩定性的影響. 醫用生物力學, 2013, 28(6): 636-641.
12.	郭剛, 余斌, 陳濱, 等. 肱骨大結節移位骨折的手術治療探討. 中華創傷骨科雜志, 2012, 14(8): 685-688.
13.	張作君. 肩部損傷診療學. 北京: 中國中醫藥出版社, 2009: 607-630.

1. Neer CS 2nd, Waston KC, Stanton FJ. Recent experience in total shoulder replacement. J Bone Joint Surg (Am), 1982, 64(3): 319-337.
2. 白露, 姜保國. 肱骨大結節骨折治療的研究進展. 中華創傷雜志, 2012, 28(2): 146-148.
3. Harper DK, Craig JG, van Holsbeeck MT. Apophyseal injuries of the lesser tuberosity in adolescents: a series of five cases. Emerg Radiol, 2013, 20(1): 33-37.
4. Teixeira RP, Johnson AR, Higgins BT, et al. Fly Fishing-related lesser tuberosity avulsion in an adolescent. Orthopedics, 2012, 35(5): e748-751.
5. Bahrs C, Lingfenfelter E, Fisher F, et al. Mechanism of injury and morphology of the greater tuberosity fracture. J Shoulder Elbow Surg, 2006, 15(2): 140-147.
6. Ohzono H, Gotoh M, Mitsui Y, et al. Isolated fracture of the lesser tuberosity of the humerus: a case report. Kurume Med J, 2011, 58(4): 131-133.
7. 黃久勤. 肩關節后脫位并肱骨大小結節骨折一例. 中華創傷雜志, 2006, 22(4): 275.
8. 丁實, 賈科鋒, 翟麗東, 等. 結節間溝及其毗鄰結構斷層解剖學研究. 解剖學研究, 2010, 32(6): 401-404.
9. 王海豐, 黃磊, 顧千里. 可吸收螺釘治療肱骨大結節骨折. 現代中西醫結合雜志, 2005, 14(1): 88-89.
10. Thanasas C, Kontakis G, Angoules A, et al. Treatment of proximal humerus fractures with locking plates: a systematic review. J Shoulder Elbow Surg, 2009, 18(6): 837-844.
11. 章偉, 陳云豐, 宋文奇, 等. 三種不同內固定方式對肱骨大結節骨折穩定性的影響. 醫用生物力學, 2013, 28(6): 636-641.
12. 郭剛, 余斌, 陳濱, 等. 肱骨大結節移位骨折的手術治療探討. 中華創傷骨科雜志, 2012, 14(8): 685-688.
13. 張作君. 肩部損傷診療學. 北京: 中國中醫藥出版社, 2009: 607-630.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment experience of proximal humerus degloving fracture

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