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

Abstract

SUMMARYFractures that split the humeral head are extremely rare, and usually, the split part is posteriorly dislocated. However, in our case, the split part was anteriorly dislocated and trapped between the anterior glenoid and the subscapularis muscle. In this case, the acquisition of preoperative CT results was vital to plan the exposure and reduction strategies. Open anatomic reduction and internal fixation should be considered as the first treatment of choice in young active adults. BACKGROUND

Anterior fracture dislocation of proximal humerus with anatomical neck fracture: Case report and review of literature

“…Silver et al [2] described one case of a two-part anterior fracture reduced percutaneously with threaded guide pins, however definitive management and its outcomes were not covered as the patient was lost to follow up. Gokkus et al [1] described a head splitting anterior dislocation managed with open reduction and fixation with 2 kirschner wires and 3 4mm AO cancellous screws, at 15 months follow-up the patient had good pain free function with a Constant shoulder score of 76 points. Several factors may have influenced this favourable outcome.…”

“…The risk of avascular necrosis with fracture dislocations at the anatomical neck of the humerus is significant however, due to their rarity, literature on the outcomes following fixation or hemiarthroplasty is limited [1][2][3][4][5][6][7][8][9] . Silver et al [2] described one case of a two-part anterior fracture reduced percutaneously with threaded guide pins, however definitive management and its outcomes were not covered as the patient was lost to follow up.…”

“…Fracture dislocation of the anatomical neck of humerus is an extremely rare injury. Of those reported the majority are posterior dislocations [1] . The management and long term outcomes following this injury are not well established; percutaneous closed reduction, open reduction internal fixation (ORIF) and hemiarthroplasty have all been described in the literature [1][2][3][4][5][6] .…”

Sword-Like Trauma to the Shoulder with Open Head-Splitting Fracture of the Head

“…Collopy and Skirving [ 7 ] reported on a 20-year-old patient who sustained a “transchondral fracture dislocation” involving 60% of the articular surface and fixed with two 4.0 mm cancellous screws; at 7-year follow-up, the patient had full range of motion and no evidence of AVN or arthritis. Gokkus et al [ 8 ] reported a complex head-splitting fracture with anterior dislocation of the fractured part on a 40-year-old patient. Surgery was performed within 6 hours and the osteochondral fragment, carrying approximately 65% of the articular surface, was found firmly entrapped between the anterior glenoid rim and the subscapularis.…”

Reverse Shoulder Arthroplasty for Proximal Humerus Head-Split Fractures—A Retrospective Cohort Study

“…Head-split PHF were first described in young male patients with high-energy trauma (i.e., a bicycle, motor or car accident) or epileptic seizures, where open reduction and internal fixation (ORIF) was considered the adequate treatment solution whenever closed reduction was not possible [ 6 ]. While these patients usually have good bone quality and the best potential for revascularization, it is important that these fractures are surgically fixed early after trauma in order to lower the risk of avascular necrosis and potential cartilage and joint degeneration [ 5 , 6 , 8 ]. Head-split fractures have also been reported in older, mainly female, patients involved in low-energy trauma (i.e., a simple fall from height) who typically have poorer bone quality and limited regenerative potential [ 2 , 7 ].…”