Monday, May 16, 2011

Complex proximal humerus fracture dislocation

A 25 year old female fell 12 feet from a ladder sustaining a complex fracture dislocation of her left shoulder. This fracture pattern carries a high risk of avascular necrosis of the humeral head which can lead to painful arthritis of the shoulder joint. Maintaining fixation to union can be challenging.

Radiographs revealed an anterior dislocation of the humeral head as well as a coracoid fracture.

Computed tomography confirmed the diagnosis and demonstrated a small amount of bone for fixation in the humeral head. Given the patient’s young age, hemiarthroplasty was not considered as a treatment option.

The humeral head was reduced after the fracture was exposed through a deltopectoral incision.

The fracture was then fixed with a periarticular locking proximal humerus plate and screw fixation of the coracoid.

At 18 month follow-up, the patient had maintained the vascularity of the humeral head and had healed the fracture. There was slight restriction of forward flexion compared to the opposite shoulder (10 degrees). The patient had minimal pain and had returned to all baseline activities.

Complex proximal humerus fracture dislocations in young adults are challenging injuries. We have extensive experience treating this injury at Harborview Medical Center and with adherence to sound surgical technique, good results are possible.

Authored By: Daphne M. Beingessner, M.D.

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