A shearing osteochondral fracture of the humeral head following an anterior shoulder dislocation in a child

Missed Osteochondral Shear Injury of the Humeral Head Following Anterior Shoulder Dislocation - A Case Report

CASE

Two months after anterior shoulder dislocation and spontaneous reduction, a 41-year-old man presented movement-related shoulder pain and a functional deficit. An initially missed osteochondral shearing injury of the humeral head with a Bankart lesion was diagnosed. Due to an extensive posteroinferior defect, an open reduction and internal fixation (ORIF) using bioabsorbable chondral darts was performed. At the 1-year follow-up, magnetic resonance images showed a completely healed osteochondral fragment and the patient presented an unrestricted shoulder function.

CONCLUSION

Even in missed osteochondral shear injuries, ORIF with bioabsorbable implants can be associated with an excellent functional outcome and sufficient integrity of the fragment. The absorbable implants are biocompatible, therefore the risk of revision surgery due to implant irritations is minimized.

Osteochondral Shearing Fracture of the Humeral Head Associated with Traumatic Anterior Shoulder Dislocation: A Case Report

CASE

Osteochondral shearing fracture of the humeral head after an anterior shoulder dislocation is a condition that has rarely been reported in literature. We report a case of a large posteriorly located fragment of such a fracture in a 23-year-old man. We performed open reduction and internal fixation with resorbable pins through a deltopectoral approach and subscapularis tenotomy.

CONCLUSION

In our case of a large osteochondral fracture of the posterior humeral head, treatment by open reduction and internal fixation showed an excellent radiographic result at 1 year and clinical result up to 5 years postoperatively.

Entrapped long head of biceps tendon in pediatric proximal humerus fracture dislocation: A case report and review of the literature

Introduction and importance

Combined proximal humerus fracture and glenohumeral dislocation in the pediatric population is extremely rare, with only few reports of such cases been reported. We review all cases of combined proximal humerus fracture and glenohumeral dislocation in the pediatric population and present a case of left proximal humerus fracture dislocation in a healthy 5-year-old girl.

Case presentation

A 5-year-old girl fell from 2 m height and landed on her left shoulder where she started to complain from severe left shoulder pain, inability to move her left shoulder and bruising. She was diagnosed at our facility to have left proximal humerus fracture combined with glenohumeral dislocation and was treated with open reduction, K-wires fixation and immobilization in a shoulder cast.

Clinical discussion

Traumatic proximal humeral fracture associated with glenohumeral dislocation is a rare presentation in pediatric age group. This type of fracture is usually managed by closed reduction and casting, with a minority being managed with open reduction. Indications for surgical intervention are open fractures, severely displaced fractures, fractures that are associated with neurovascular compromise, or irreducible fracture due to soft tissue obstacles.

Conclusions

A high index of suspicion is required to diagnose such injuries along with appropriate radiographic evaluation. We recommend open reduction with K-wires fixation for irreducible combined proximal humeral fracture and glenohumeral dislocation.

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Combined proximal humerus fracture & glenohumeral dislocation in the pediatric population is extremely rare occurrences

•High index of suspicion is required to diagnose such injuries along with appropriate radiographic evaluation

•Open reduction with K-wires fixation for irreducible combined proximal humeral fracture & glenohumeral dislocation is the best treatment option.

Shearing Osteochondral Fracture of the Humeral Head: A Case Report

CASE

A 30-year-old man was found to have a posteriorly displaced osteochondral shear fracture of his left humeral head, likely from dislocation and relocation. The fragment was fixed in its native position using headless screws, and the patient regained full strength and range of motion within 9 months.

CONCLUSIONS

Osteochondral shear fractures of the humeral head appear to shear off the anteromedial articular joint surface after dislocation and relocation. One should be suspicious for associated labral tears. Arthroplasty is a valid treatment option, but select patients may be eligible for other viable options.

Shoulder dislocation combined with proximal humerus fracture in children: A case report and literature review

RATIONALE

Proximal humerus fracture occuring simultaneously with dislocation of a shoulder in children is extremely rare, with only a few recent reports of on such cases having been reported.

PATIENT CONCERNS

A 6-year-old girl fell from a ladder and landed on her dominant right arm with pain in the right shoulder and unable to perform movements; her shoulder did not allow for passive movements as well.

DIAGNOSES

Proximal humerus fracture combined with shoulder dislocation.

INTERVENTIONS

The patient was treated with open reduction, elastic stable intramedullary nail (ESIN) fixation, immobilization with U-shape cast and shoulder spica brace.

OUTCOMES

The patient was pain-free, with full range movement of the injured shoulder and no sign of avascular necrosis in a 2-year follow-up period.

LESSONS

We recommend open reduction with ESIN fixation for severely displaced proximal humeral metaphyseal fractures with shoulder dislocation in children. Preoperative bilateral anteroposterior shoulders x-ray is needed to confirm the shoulder location.

Osteochondral humeral head fracture after posterior shoulder subluxation: A case report

Traumatic posterior shoulder subluxations are rare entities which require clinical suspicion upon presentation. Although literature presents many sequels of posterior shoulder subluxations, we have not come across any shearing type osteochondral fracture in the literature. In this case report we present diagnosis, treatment and follow-up results of this rare fracture in a 26-year-old male following a fall from a motorcycle.

The current state of imaging the articular cartilage of the upper extremity

MR imaging has increasingly been used to image joints since its inception. Historically, there has been more emphasis on the evaluation of internal derangement rather than cartilaginous disease. This article reviews cartilaginous diseases of the upper extremity emphasizing those that can be assessed using current clinical MR imaging protocols and addresses the limitations of current imaging techniques in evaluating the articular cartilage of smaller joints. It also provides a brief overview of novel techniques that may be instituted in the future to improve the diagnostic performance of MR imaging in the evaluation of the articular cartilage of the upper extremity.