Post-traumatic osteonecrosis of the proximal humerus after Salter Harris I fracture

Case contributed by Domenico Nicoletti
Diagnosis certain


Fall on shoulder during soccer match.

Patient Data

Age: 15 years
Gender: Male

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.

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.

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).

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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