Avascular necrosis after fracture dislocations of the proximal humerus

Case contributed by Dr Domenico Nicoletti


Left proximal humerus 4-part fracture.

Patient Data

Age: 35 years
Gender: Male

Rx left shoulder

 After osteosynthesis with locking plate neck shaft angle and medial support were restored.

CT left shoulder

Proximal humeral head fracture with extension to the shaft treated with plate osteosynthesis.

After 1 year, the patient complained of pain on movement.

Rx left shoulder

Stage III avascular necrosis (according to Cruess) of the humeral head with following loss of sphericity of the articular segment and medialization of the center of rotation with beginning glenoid erosion.

CT left shoulder

Avascular necrosis and screw penetration of humeral head following plate osteosynthesis.

Rx left shoulder

Humeral head fracture treated with hemiarthroplasty.

Case Discussion

In fracture-dislocations, an even higher risk of avascular necrosis might be considered owing to the limited blood supply of the humeral head. Humeral head osteonecrosis is frequently in patients who have undergone internal fixation. Early stabilization of these fractures could therefore be expected to reduce ischemic time for the humeral head. Hemiarthroplasty is a good solution for comminuted 3 and 4-part fractures of proximal humerus providing pain relief. The key point for hemiarthroplasty success is tuberosity healing, which offers satisfactory outcomes and a good range of motion. In the case of tuberosity resorption, nonunion, or malunion poor outcomes are often seen.

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Case information

rID: 88078
Published: 25th Mar 2021
Last edited: 28th Mar 2021
Inclusion in quiz mode: Included

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