گزارش يك مورد دررفتگي تحتاني باز شانه(لوكساشيا) با اسيب نورو واسكولار

Unusual Open Inferior Glenohumeral Dislocation (Luxatio Erecta Humeri) with Illustration Neurovascular Injuries: A Case Report

در رفتگي تحتاني شانه نوع نادري از درفتگي هاي شانه است كه با اسيب هاي نوروواسكولار مي تواند همراهي داشته باشد. در اين گزارش بيماراقاي 40 ساله با دررفتگي باز(open dislocation) به صورت اكسپوز شدن سر هومروس در ناحيه اگزيلاري معرفي شده است. اسيب همزمان عروقي و عصبي به صورت گير كردن شريان براكيال وجود داشته است. پارگي وسيع در كپسول اينفريور باعث قفل شدن و عدم امكان جااندازي بسته(closed reduction) شده بود و نياز به جا اندازي باز بود. با توجه به بالا بودن اسيب هاي نوروواسكولار همزمان در درفتگي هاي تحتاني شانه معاينه دقيق عروقي اهميت بسيار دارد و تلاش براي جااندازي بسته مي تواند باعث افزايش عوارض گردد.

Luxatio erecta humeri (LEH) refers to a rare glenohumeral dislocation that may be accompanied by neurovascular injuries. Regarding the low prevalence of this type of dislocation, little knowledge is available in this field. This report presents a 40-year-old man with open dislocation in which the humerus head was exposed in the axillary site. Neurovascular injuries also occurred in the form of brachial artery involvement. Extensive tears in the inferior capsule resulted in the lockage and impossibility of closed reduction; thus open reduction was required. A severe instability existed due to the subscapularis tendon rupture and the anterior and inferior capsule. After reduction, tendon and capsule were repaired by ethibond excel nonabsorbable polyester. The patient's movement started 4 weeks after the surgery which exhibited complete stability. 4-month follow-up indicated that the radial and ulnar nerves paralysis were resolved and the normal function was retained. Regarding high neurovascular injuries in the inferior glenohumeral dislocations, a precise vascular examination is of crucial importance. Therefore, attempts for closed reduction may further increase the neurovascular complications.