A new classification for combined greater tuberosity fracture and anterior shoulder dislocation: A study of fracture configurations and displacement after reduction.

IF 1.1 4区 医学 Q3 ORTHOPEDICS Acta orthopaedica et traumatologica turcica Pub Date : 2022-07-01 DOI:10.5152/j.aott.2022.21316
Phob Ganokroj, Narin Pakawech, Bavornrat Vanadurongwan, Thos Harnroongroj, Thossart Harnroongroj, Ekavit Keyurapan
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引用次数: 2

Abstract

Objective: The aim of this study was to propose a new classification of combined greater tuberosity (GT) fractures and anterior shoulder dislocation and studied the degree of displacement, functional outcomes, and need for additional surgery after reduction.

Methods: A cross-sectional study was conducted. We evaluated radiographs of patients treated for combined GT fractures and anterior shoulder dislocation. Three morphologies were proposed; type 1 (a small avulsion), type 2 (GT fractures without articular head involvement), and type 3 (GT associated with articular head fractures). Two orthopedic surgeons independently measured all radiographs and classified fractures into three types. Patients were interviewed by telephone to assess functional outcomes (the simple shoulder test (SST) and EQ-5D-5L), and additional shoulder surgery was also performed.

Results: There were 52 eligible patients; 32 were male (61.5%) and the mean age was 57.3 · 17.1 years. Most cases were low-energy injuries (61.5%). Of all the cases, 32.7% were type I, 59.6% type II, and 7.7% type III cases. There were differences in the degree of displacement in each group at pre, post-reduction (both horizontal and vertical planes) and at two weeks post-reduction for HD (p < 0.05). Type III had more displacement than type I at pre- and post-reduction with a P value of less than 0.05. Type III also had higher rates of displacement than type II at post-reduction and at two-week postreduction (vertical plane). The intra and inter-rater reliabilities of measurement (ICC > 0.8) were in good to excellent agreement with the kappa value (>0.9). Three out of 52 cases (5.8%) required an additional surgery after closed reduction. Patients had good functional outcomes (SST score of 8) with an excellent utility index of EQ-5D-5L (0.9).

Conclusion: This new classification exhibited good-to-excellent intra-and inter-rater reliabilities, with an ability to determine injury type. Type III seems to be linked to higher risk of fracture displacement and may require additional surgery.

Level of evidence: Level IV, Diagnostic Study.

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合并大结节骨折和肩前脱位的新分类:复位后骨折形态和移位的研究。
目的:本研究的目的是提出合并大结节(GT)骨折和肩前脱位的新分类,并研究复位后移位程度、功能结局和是否需要进一步手术。方法:采用横断面研究。我们评估了合并GT骨折和前肩脱位的患者的x线片。提出了三种形态;1型(小撕脱),2型(GT骨折不累及关节头)和3型(GT合并关节头骨折)。两名骨科医生独立测量了所有的x线片,并将骨折分为三种类型。通过电话访谈患者以评估功能结果(简单肩部测试(SST)和EQ-5D-5L),并进行额外的肩部手术。结果:符合条件的患者52例;男性32例(61.5%),平均年龄57.3·17.1岁。以低能损伤为主(61.5%)。其中ⅰ型占32.7%,ⅱ型占59.6%,ⅲ型占7.7%。各组HD复位前、复位后(水平和垂直平面)和复位后2周的移位程度差异有统计学意义(p < 0.05)。III型复位前后移位量大于I型,P值均小于0.05。在复位后和复位后两周(垂直平面),III型的移位率也高于II型。测量的内、间信度(ICC > 0.8)与kappa值(>0.9)符合良好或极好。52例中有3例(5.8%)需要在闭合复位后进行额外手术。患者功能预后良好(SST评分为8分),EQ-5D-5L效用指数为0.9。结论:这种新的分类具有良好到优异的内部和内部可靠性,能够确定损伤类型。III型似乎与骨折移位的高风险有关,可能需要额外的手术。证据等级:四级,诊断性研究。
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来源期刊
CiteScore
2.00
自引率
0.00%
发文量
66
审稿时长
>12 weeks
期刊介绍: Acta Orthopaedica et Traumatologica Turcica (AOTT) is an international, scientific, open access periodical published in accordance with independent, unbiased, and double-blinded peer-review principles. The journal is the official publication of the Turkish Association of Orthopaedics and Traumatology, and Turkish Society of Orthopaedics and Traumatology. It is published bimonthly in January, March, May, July, September, and November. The publication language of the journal is English. The aim of the journal is to publish original studies of the highest scientific and clinical value in orthopedics, traumatology, and related disciplines. The scope of the journal includes but not limited to diagnostic, treatment, and prevention methods related to orthopedics and traumatology. Acta Orthopaedica et Traumatologica Turcica publishes clinical and basic research articles, case reports, personal clinical and technical notes, systematic reviews and meta-analyses and letters to the Editor. Proceedings of scientific meetings are also considered for publication. The target audience of the journal includes healthcare professionals, physicians, and researchers who are interested or working in orthopedics and traumatology field, and related disciplines.
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