Post-traumatic osteonecrosis of the proximal humerus after Salter Harris I fracture
Presentation
Fall on shoulder during soccer match.
Patient Data
Right shoulder
Salter-Harris type I fracture, which extends through the growth plate (physis) of the proximal humerus. The humeral head has slipped off the humeral shaft in varus alignment.
Right shoulder
Anatomical reduction of the humeral head, which was medially dislocated, successfully achieved the original position and the fracture fragment was fixed using two Steinmann pins.
Follow up after two months
There is a modest osteopenia which delimits an area of relatively increased bone density in the medial portion of the head. The sphericity of the humeral head and the joint space are preserved (Stage II Cruess classification of humeral head osteonecrosis).
Follow up six months
In the medial portion of the humeral head, there’s a crescent sign from collapse or fracture of the subchondral bone (Stage III Cruess classification of humeral head osteonecrosis).
Case Discussion
Type I fractures of Salter-Harris classification of physeal fractures disrupt the physis. Avascular necrosis (AVN) of the humeral head is a short-term complications after reconstructive surgery of proximal humerus fractures. In fracture dislocations there is an increased risk of AVN due to the limited blood supply of the humeral head. In dislocation fractures of the humeral head, early reconstructive surgery within 48 hours of injury significantly reduces the risk of AVN. Poor fracture reduction led to higher complication rates.
Case courtesy: Dr.ssa Laura Braccaioli
Radiographer: TSRM Fabio Imola
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