Fractures involving splitting of the humeral head

Abstract

Splitting fractures of the humeral head are rare; part of the humeral head dislocates and the unfractured part remains attached to the shaft. We report eight cases in young patients. In five the diagnosis was made at presentation: three had minimal internal fixation using a superior subacromial approach, one had a closed reduction and one a primary prosthetic replacement. All five patients regained excellent function with no avascular necrosis at two years. In three the injury was initially unrecognised; two developed a painless bony ankylosis and one is awaiting hemiarthroplasty.It is important to obtain the three trauma radiographic views to diagnose these unusual fractures reliably. CT delineates the configuration of the fracture. In young patients open reduction and internal fixation seems preferable to replacement of the humeral head, since we have shown that the head is potentially viable.

Locked plate osteosynthesis of humeral head–splitting fractures in young adults

“…Apart from case reports, only a single case series has been published exclusively on osteosynthesis of isolated simple head-splitting fractures. 2,3,17 The authors described good results with internal fixation in simple head-splitting fractures in 3 of the 8 patients who were young (19-41 years) and opted for hemiarthroplasty in patients >55 years. 2 In our study, all patients were younger than 55 years, and the majority of the fractures were complex, indicating higher energy violence and possibly more disruption of the humeral head blood supply.…”

Proximal humerus head-splitting fracture associated with single-part anterior dislocation

“…Chesser et al 7 reported eight cases of head-splitting fracture-dislocations of the humeral head. We closely examined their cases and realised that their cases seemed to be classified as posterior fracture-dislocations rather than anterior fracture-dislocations.…”

“…Chesser et al 7 used the superior subacromial approach, which was popularised by Stableforth and Sarangi,9 to treat a posterior fracture-dislocation of the humeral head.…”

Complex head-splitting fracture–dislocation of the proximal humerus successfully treated with minimal internal fixation: A case report and discussion

“…5,7 Head-splitting fractures of the humerus with subluxation or dislocation may occur in the young but they are rare and difficult to treat, with relatively few cases reported in the literature. 1,4 There is insufficient data in the current literature for evidence-based decision-making with regards to the treatment of complex proximal humeral fractures. 6 Head-splitting fractures occur as a result of violent compression of the head against the glenoid; 2 the head splits and the tuberosities may remain attached to the fragments, or split and separate.…”