Реверсивное эндопротезирование плечевого сустава после оскольчатого перелома плечевой кости: клинический случай

Background. Fractures of the proximal humerus are common injury, especially among older age group patients. For the treatment of most cases, conservative tactics are required, some require surgery: osteosynthesis, arthroplasty. Proximal humerus fractures with extension to the metadiaphyseal and diaphyseal zones uncommon, and treatment of this type of injuries is complex for trauma surgeons. The aim of the study is to demonstrate successful experience of two-stage treatment of the proximal humerus fracture with extension to the diaphysis middle third in an older age group patient. Case presentation. The clinical case presents successful two-stage treatment of the proximal humerus fracture with extension to the middle third of the diaphysis in an older age group patient. The first stage was performed osteosynthesis of the humerus with the PHILOS Long plate, the second stage reverse shoulder arthroplasty. Conclusion. Consistent performing of osteosynthesis and total reverse shoulder arthroplasty allows to achieve satisfactory treatment results with restoration of the injured limb function and relief of pain syndrome.Актуальность. Переломы проксимального отдела плечевой кости распространенная травма, особенно среди пациентов старшей возрастной группы. Для лечения большинства данных повреждений применяется консервативная тактика, однако некоторым пациентам требуется хирургическое лечение: остеосинтез, эндопротезирование. Переломы проксимального отдела плечевой кости с распространением на метадиафизарную и диафизарную зоны встречаются значительно реже, и их лечение представляет сложную задачу для травматологов. Описание случая. Представлен успешный опыт двухэтапного лечения перелома проксимального отдела плечевой кости с распространением до средней трети диафиза у пациентки старшей возрастной группы. Первым этапом выполнен остеосинтез плечевой кости пластиной PHILOS Long, вторым этапом реверсивное эндопротезирование плечевого сустава. Заключение. Последовательное применение остеосинтеза и тотального реверсивного эндопротезирования плечевого сустава позволяет добиться удовлетворительных результатов лечения с восстановлением функции травмированной конечности и купированием болевого синдрома

Pigmented villonodular synovitis of the subarocmial space (case report)

Pigmented villonodular synovitis (PVNS) is a rare benign proliferative disorder affecting synovial membranes, bursae, tendons, skin and bone. Materials The article presents a rare clinical case treated for PVNS of the subacromial space. The patient complained of pain in the shoulder joint at the largest possible points, and a deformity developed 7 months prior to the visit could be visualized at the anterior aspect of the shoulder joint. The patient denied any history of trauma. Arthroscopy of the shoulder joint was performed to rule out the intraarticular nature of the lesion with an exploratory puncture performed to establish the diagnosis with instrumental methods. Delto-pectoral approach was used to remove the neoplasm that was histologically examined to confirm the diagnosis. The upper limb was postoperatively immobilized with a Gilchrist-bandage for 2 weeks. The sutures were removed 2 weeks after the operation. Result The patient underwent a course of rehabilitation to restore the function of the upper limb. The upper limb function was preoperatively and postoperatively evaluated with the ASES questionnaire. The patient showed the shoulder function completely regained at two years with ASES scored 100. MRI scan of the shoulder joint showed no signs of recurrence. Extra-articular location of PVNS is very rare and is described in few case reports. Open procedure or arthroscopic removal of the affected synovial membrane are used to treat the condition. Conclusion Removal of the affected synovial membrane allowed us to obtain a good clinical result © Ryazantsev M.S., Magnitskaya N.E., Ilʼin D.O., Logvinov A.N., Kadantsev P.M., Frolov A.V., Olchev A.A., Korolev A.V., 202