非観血的に治療した肩関節後方脱臼骨折の1例

Posterior Fracture-dislocation of the Shoulder Treated Non-operatively. Case Report

　肩関節後方脱臼骨折は診断，整復が困難で，観血的治療を要することが多い．今回われわれは非観血的に治療した1例を経験したので報告する．症例は47歳，男性，自転車乗用中に転倒し受傷した．即日単純X線，CTにより上腕骨解剖頚の骨折を伴う左肩関節後方脱臼骨折と診断し，受傷後4日目に全身麻酔下に徒手整復した．整復後骨折部は安定し，内固定を要さなかった．受傷後1年，後療法の中断でJOAスコアは80点にとどまるが，骨癒合は良好で骨頭壊死はない．術後合併症の危険性を減らすためにも早期診断と非観血的治療の重要性を強調したい．

　Posterior fracture dislocation of the shoulder is rare and difficult to diagnose. Reduction often requires surgical intervention. We report a case treated nonoperatively. A 47-year-old man who fell while riding his bicycle and seen on the day of the accident was found in X-ray and computed tomography (CT). Posterior fracture and dislocation of his left shoulder. We reduced the fracture dislocation manually 4 days after injury, gaining satisfactory stability of the shoulder joint and fracture. One year after injury, bone union was attained. No avascular necrosis of humeral head occurred. This underlines the importance of early diagnosis and nonoperative therapy to avoid surgical complications.