Abstract:
:Fractures of the scapula are rare and have an incidence of 1% of all fractures. Publications highlight glenoid rim fractures. Classification by Ideberg and Euler and Rüdi are accepted. Euler and Rüdi describe three extra-articular and two intra-articular fracture patterns. The indications for surgery are displaced glenoid fractures, scapula tilt of more than 40° and injuries to the superior shoulder suspensory complex. We describe a case of a 22 year old man, who while cycling collided with a moving car due to wet roads. After his admission to hospital as a polytraumatised patient, the trauma CT-Scan showed haemothorax with several associated rip fractures, displaced humeral shaft fracture and fractures of the acromion and glenoid, classified as type D2c according to Euler and Rüdi. Following damage control principles, drainage of the haemothorax was already performed in the ER and surgical treatment of the displaced humeral shaft fracture was performed on the day of admission. No peripheral neurological deficits were evident. After pulmonary stabilisation, surgery was performed 6 days later on the glenoid and acromion fracture, which in conjunction may be regarded as an injury to the superior shoulder suspensory complex. We performed an arthroscopically-assisted screw fixation of the glenoid fracture (type D2c according to Euler and Rüdi) and an ORIF procedure at the acromion. Postoperative rehabilitation was performed with passive abduction and elevation up to 90° for the first two weeks and active abduction an elevation up to 90° for weeks 3 to 6. Full ROM was allowed at week 7. CONCLUSION:Articular fractures of the glenoid are rare and mainly seen as rim fractures. The indications for surgery are displaced articular fractures and injury to the superior shoulder suspensory complex. As demonstrated by this article, type D2c fractures according to Euler and Rüdi can be treated effectively as an arthroscopically-assisted screw fixation procedure. :Skapulafrakturen sind selten und machen 1% aller Frakturen aus. Klassifiziert werden Skapulafrakturen nach Ideberg oder Euler und Rüdi, wobei hier 3 extraartikuläre und 2 intraartikuläre Frakturformen unterschieden werden. Eine OP-Indikation besteht bei dislozierten intraartikulären Frakturen und Schädigung des „superior shoulder suspensory complex“. Wir berichten über den Fall eines 22-jährigen Mannes, der als Fahrradfahrer mit einem Pkw kollidierte und als polytraumatisierter Patient notarztbegleitet über den Schockraum vorgestellt wurde. Dem Damage-Control-Prinzip entsprechend erfolgte noch am Aufnahmetag die Anlage einer Thoraxsaugdrainage bei Hämatopneumothorax und Rippenserienfraktur sowie die Osteosynthese einer Humerusschaftfraktur mittels eines Humerusmarknagels. Die periphere Sensibilität und Durchblutung waren zu jeder Zeit intakt. Nach Stabilisierung des Patienten schloss sich 6 Tage später die Versorgung der Skapulafraktur (Typ D2c nach Euler und Rüdi) und Akromionfraktur an. Die Skapulafraktur wurde arthroskopisch unterstützt als minimalinvasive Schraubenosteosynthese und die zusätzlich bestehende Akromionfraktur mittels Plattenosteosynthese versorgt. Die Nachbehandlung bestand in einer passiven Beübung bis 90° für Anteversion und Abduktion innerhalb der ersten 2 Wochen mit aktiver Beübung bis 90° für die 3. – 6. Woche. Freigabe ab der 6. Woche. FAZIT:Gelenkbeteiligende Skapulafrakturen sind seltene Frakturen und betreffen meist den Glenoidrand. OP-Indikationen bestehen bei dislozierten intraartikulären Frakturen sowie Verletzungen des „superior shoulder suspensory complex“. Intraartikuläre Frakturen Typ D2c nach Euler und Rüdi können erfolgreich arthroskopisch gestützt als minimalinvasive Schraubenosteosynthesen durchgeführt werden.
journal_name
Z Orthop Unfalljournal_title
Zeitschrift fur Orthopadie und Unfallchirurgieauthors
Kornherr P,Konerding C,Kovacevic M,Wenda Kdoi
10.1055/a-0576-2036subject
Has Abstractpub_date
2018-08-01 00:00:00pages
443-448issue
4eissn
1864-6697issn
1864-6743journal_volume
156pub_type
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