معرفي يك مورد دررفتگي تحتاني مفصل شانه همراه با شكستگي توبروزيتي بزرگ هومروس

A Case Report of Inferior Dislocation of Shoulder (Luxatio Erecta)

ﺯﻣﻴﻨﻪ ﻭ ﻫﺪﻑ: ﺩﺭﺭﻓﺘﮕﻲ ﺷﺎﻧﻪ ﻳﮑﻲ ﺍﺯ ﺩﺭﺭﻓﺘﮕـﻲ ﻫﺎﻱ ﺷﺎﻳﻊ ﻣﻔﺎﺻﻞ ﺑﺰﺭﮒ ﺑﺪﻥ ﺍﺳﺖ ﮐﻪ ﺍﻏﻠـﺐ ﺑﻪ ﺷﻜﻞ ﻗـﺪﺍﻣﻲ ﺍﺳﺖ. ﺩﺭﺭﻓﺘﮕﻲ ﺗﺤﺘﺎﻧﻲ ﺷﺎﻧﻪ ﻧﻮﻉ ﻧﺎﺩﺭﻱ ﺍﺳﺖ ﮐﻪ ﮐﻤﺘﺮ ﮔـﺰﺍﺭﺵ ﺷﺪﻩ ﺍﺳﺖ، ﻟﺬﺍ ﺁﮔﺎﻫﻲ ﮐﺎﻓﻲ ﺍﺯ ﻋـﻮﺍﺭﺽ ﻭ ﻧﺘﺎﻳﺞ ﺁﻥ ﻭﺟـﻮﺩ ﻧﺪﺍﺭﺩ. ﻣﻮﺍﺩ ﻭ ﺭﻭﺵ ﻫﺎ: ﺁﻗﺎﻱ 40 ﺳﺎﻟﻪ ﻣﺘﻌﺎﻗﺐ ﺗﺼﺎﺩﻓﻲ ﺭﺍﻧﻨﺪﮔﻲ ﺑﺎ ﻭﺿﻌﻴﺖ ﺍﺑﺪﺍﮐﺸـﻦ ﺷﺎﻧﻪ ﻭ ﺍﮐﺴﺘـﺮﻧﺎﻝ ﺭﻭﺗﻴﺸـﻦ ﺑﺎﺯ ﻭ ﻫﻤـﺮﺍﻩ ﺑﺎ ﺍﻓـﺖ ﻓﺸﺎﺭ ﺧـﻮﻥ ﻭ ﺗﻨـﺪﺭﻧﺲ ﺷﮑـﻢ ﺑﻪ ﺑﻴﻤﺎﺭﺳﺘـﺎﻥ ﺁﻭﺭﺩﻩ ﻣﻲ ﺷـﻮﺩ ﻭ ﺩﺭ ﻫﻤـﺎﻥ ﺍﺑﺘﺪﺍ ﺗﻮﺳـﻂ ﺳﺮﻭﻳﺲ ﺟـﺮﺍﺣﻲ ﺗﺤـﺖ ﻋﻤـﻞ ﻻﭘﺎﺭﻭﺗـﻮﻣﻲ ﻭ ﺧﺎﺭﺝ ﮐـﺮﺩﻥ ﻃﺤﺎﻝ ﻗﺮﺍﺭ ﻣﻲ ﮔﻴﺮﺩ. ﺩﺭ ﺭﺍﺩﻳﻮﮔﺮﺍﻓﻲ ﺷﺎﻧﻪ ﻭﻱ ﺩﺭﺭﻓﺘﮕﻲ ﺗﺤﺘﺎﻧﻲ ﺷﺎﻧﻪ ﻫﻤﺮﺍﻩ ﺑﺎ ﺷﮑﺴﺘﮕـﻲ ﺗﻮﺑﺮﻭﺯﻳﺘﻲ ﺑﺰﺭﮒ ﻫﻮﻣﺮﻭﺱ )Luxatio Erecta( ﻣﺸﺎﻫﺪﻩ ﻣﻲ ﺷﻮﺩ ﮐﻪ ﻫﻤﺰﻣﺎﻥ ﺑﺎ ﻋﻤـﻞ ﺳﺮﻭﻳﺲ ﺟﺮﺍﺣﻲ ﻭ ﺩﺭ ﻫﻤـﺎﻥ ﺑﻴﻬـﻮﺷﻲ ﺑﺮﺍﻱ ﻭﻱ ﺟﺎ ﺍﻧـﺪﺍﺯﻱ ﺷﺎﻧﻪ ﺻﻮﺭﺕ ﻣﻲ ﮔﻴﺮﺩ. ﺍﻣﺎ ﻗﻄـﻌﻪ ﺷﮑﺴﺘﻪ ﺗﻮﺑﺮﻭﺯﻳﺘﻲ ﻫﻮﻣﺮﻭﺱ ﺑﻪ ﺻـﻮﺭﺕ ﺁﻧﺎﺗﻮﻣﻴـﮏ ﺟﺎ ﺍﻧـﺪﺍﺯﻱ ﻧﻤﻲ ﺷـﻮﺩ ﻭ ﺑﻪ ﻧﻈـﺮ ﻣﻲ ﺁﻳـﺪ ﺩﺍﺧﻞ ﻣﻔﺼﻞ ﮔﻴﺮ ﮐﺮﺩﻩ ﺑﺎﺷـﺪ ﻟﺬﺍ ﺑﻌﺪ ﺍﺯ ﺑﻬﺒﻮﺩﻱ ﺣﺎﻝ ﻋﻤـﻮﻣﻲ ﺑﻴﻤـﺎﺭ ﻭ ﺩﺭ ﻣـﺮﺣﻠﺔ ﺑﻌـﺪﻱ، ﺟﺎ ﺍﻧﺪﺍﺯﻱ ﺑﺎﺯ ﻭ ﻓﻴﮑﺴﺎﺳﻴـﻮﻥ ﺩﺍﺧﻠﻲ ﻗﻄـﻌﻪ ﻣﺬﮐﻮﺭ ﺻﻮﺭﺕ ﻣﻲ ﮔﻴﺮﺩ. ﻧﺘﻴﺠﻪ ﮔﻴـﺮﻱ: ﺑﺨﺎﻃﺮ ﻧﺎﺩﺭ ﺑﻮﺩﻥ ﺩﺭﺭﻓﺘﮕﻲ ﺗﺤﺘﺎﻧﻲ ﺷﺎﻧﻪ، ﻫﻨﻮﺯ ﻧﻤﻲ ﺗﻮﺍﻥ ﺍﺯ ﻧﻈﺮ ﻋـﻮﺍﺭﺽ ﻭ ﻧﺘﺎﻳﺞ ﺁﻥ ﺭﺍ ﺑﺎ ﺩﺭﺭﻓﺘﮕﻲ ﻗـﺪﺍﻣﻲ ﺷﺎﻧﻪ ﮐﻪ ﺑﺴﻴﺎﺭ ﺷﺎﻳﻊ ﺗﺮ ﺍﺳﺖ ﻣﻘﺎﻳﺴﻪ ﮐﺮﺩ. ﻭﻟﻲ ﺑﻪ ﻧﻈﺮ ﻣﻲ ﺭﺳﺪ ﺗﺮﻭﻣﺎﻱ ﺷﺪﻳﺪﺗﺮﻱ ﺑﺎﻋـﺚ ﺍﻳﻦ ﻧﻮﻉ ﺩﺭﺭﻓﺘﮕـﻲ ﻣﻲ ﺷﻮﺩ ﻭ ﻧﻴﺰ ﺟﻬـﺖ ﺟﺎﺑﺠﺎﻳﻲ ﻃﻮﺭﻱ ﺍﺳﺖ ﮐﻪ ﻧﺴﻮﺝ ﺑﻴﺸﺘﺮﻱ ﺻﺪﻣﻪ ﻣﻲ ﺑﻴﻨﻨﺪ ﻟﺬﺍ ﺑﺎ ﺟﺎﺍﻧﺪﺍﺯﻱ ﺷﺎﻧﻪ ﺷﺎﻧﺲ ﺭﻳﺪﺍﮐﺸﻦ ﺁﻧﺎﺗﻮﻣﻴﮏ ﺗـﻮﺑﺮﻭﺯﻳﺘﻲ ﺑﺰﺭﮒ ﻫـﻮﻣﺮﻭﺱ ﮐﻤﺘﺮ ﺑﻮﺩﻩ ﻭ ﻧﻴﺎﺯ ﺑﻪ ﺟﺮﺍﺣﻲ ﺷﺎﻳﺪ ﺑﻴﺸﺘﺮ ﺑﺎﺷﺪ.

Introduction & Objective: Shoulder dislocation is one of the most common dislocations of large joints and anterior type is the most common type of it. Inferior shoulder dislocation is a rare type. There are few reported cases about this kind of dislocation so complications and results of it are not fully understood. Materials & Methods: A 40 year old man who injured in a car accident, has been referred to emergency room. His arm was held in the position of abduction and external rotation. He had refractory hypotension which needed emergent spelenectomy. In the same anesthesia we reduced his shoulder dislocation but the fractured greater tuberosity did not reduced completely to its anatomic position was not normal and also it seemed to be intraarticular and caused joint incongruity; so after several days and after the patient became stable, open reduction and internal fixation of greater tuberosity of humerus were done. Conclusions: Because of rarity of inferior dislocation of shoulder, we cannot compare inferior shoulder dislocation with anterior shoulder dislocation (which is more common) in their complications and results, but it seems that higher energy trauma is needed to cause inferior dislocation of shoulder and also direction of dislocation of head causes more injury to adjacent soft tissues, so after reduction of shoulder, the chance of anatomic reduction of greater tuberosity of humerus is low in this type and the need for surgery is higher