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2011, vol. 139, br. 5-6, str. 370-375
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Spoljašnja skeletna fiksacija ramenog zgloba nakon strelnog ranjavanja s potpunim uništenjem glave humerusa - prikaz slučaja
External fixation in the treatment of shooting proximal humeral fracture with bone defect: A case report
Golubović Zorana, Vukašinović Zoranb, Stanić Vojkanc, Stojanović Sašaa, Stojiljković Predraga, Stojiljković Danilod, Golubović Ivana, Micić Ivana  , Radovanović Zorand, Kostić Igora, Višnjić Aleksandard , Najman Stevod
aKlinički centar Niš, Klinika za ortopediju bUniverzitet u Beogradu, Medicinski fakultet + Univerzitet u Beogradu, Medicinski fakultet, Institut za ortopedsko-hirurške bolesti 'Banjica' cVojnomedicinska akademija, Beograd dUniverzitet u Nišu, Medicinski fakultet
e-adresa: golubovicz@bankerinter.net
Projekat: Retke bolesti: molekularna patofiziologija, dijagnostički i terapijski modaliteti i socijalni, etički i pravni aspekti (MPNTR - 41004)
Virtuelni koštano zglobni sistem čoveka i njegova primena u pretkliničkoj i kliničkoj praksi (MPNTR - 41017)
Sažetak
Uvod. Strelne penetrantne povrede ramenog zgloba s uništenjem glave humerusa su veoma teške povrede koštano-zglobnog sistema čoveka. Prikaz bolesnika. Muškarac star 74 godine povređen je ranjavanjem lovačkom puškom u predelu levog ramenog zgloba. Grub neurocirkulatorni nalaz pri prijemu bio je normalan. Nakon kratkotrajne reanimacije i rendgenografije grudnog koša i levog ramena, obavljene su primarna hirurška obrada rane u opštoj endotrahealnoj anesteziji i stabilizacija ramenog zgloba spoljašnjim skeletnim fiksatorom prema Mitkoviću s konvergentnom orijentacijom klinova. Dva klina spoljašnjeg skeletnog fiksatora postavljena su u srednji deo dijafize humerusa, a dva klina u vrat lopatice, s obzirom na to da je akromion leve lopatice bio polomljen projektilima lovačke puške. Zaključak. Nakon hirurške obrade strelne rane stabilizacija ramenog zgloba se može izvršiti spoljašnjim skeletnim fiksatorom. Kada to nije moguće, klinove spoljašnjeg skeletnog fiksatora treba postaviti u korakoidni nastavak i akromion. Klinovi se mogu postaviti i u vrat lopatice, što je urađeno u prikazanom slučaju, čime se postiže dobra stabilnost povređenog ramenog zgloba i omogućava nesmetani pristup rani radi previjanja i rekonstruktivnih operacija.
Abstract
Introduction. Shooting injuries of shoulder with destruction of proximal humerus are rare and severe orthopaedic injuries. Case Outline. A 74-year-old patient was wounded at close range by a shotgun. He was wounded in the left shoulder and suffered a massive defect of the proximal humerus and soft tissue. The neurocirculatory finding of the injury extremity was normal. After a short resuscitation, x-ray of the thorax and the left shoulder registered a complet destruction of humeral head. After the primary treatment of the wound under general endotracheal anesthesia, the shoulder was stabilized with an external fixator type Mitkovic, with convergent orientation of the pins, where two pins were placed in the neck of scapula and two in the humeral shaft, because the left scapular acromion was fractured by shotgun projectiles. Conclusion. After radical wound debridement, external fixation is the method of choice for shoulder stabilisation in shooting injury of shoulder with bone defect. If this is not possible, pins of the left external skeletal fixator should be placed into the coracoid process and acromion. The pins can be also placed into the humeral shaft, as done in the presented case, and by which a good stability of the injured proximal humerus, easy approach to the wound for bandaging and reconstructive surgery can be achieved.
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