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

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.

Glenohumeral joint dislocation is rare in children with proximal humeral fractures: a descriptive study and literature review

Background

Glenohumeral dislocation combined with fracture of the proximal humerus is extremely rare in children, and this study aims to investigate its incidence in the pediatric population and review the treatment strategy for this condition.

Methods

Between Jan 2014 and Jan 2019, 280 patients with unilateral proximal humeral fractures were retrospectively reviewed. Imaging and follow-up notes were reviewed for patients with a predilection for glenohumeral joint dislocation. Six (2.14%) patients between the ages of 5 and 10 years were confirmed as glenohumeral joint dislocation and included in the study. All these patients underwent closed reduction and external fixation under general anesthesia.

Results

Out of 280 patients with proximal humeral fractures, only 6 patients, including 4 males and 2 females, were confirmed as glenohumeral joint dislocation. ROM was normal compared with the contralateral shoulder in every patient at the last follow-up. There was no case of radiological abnormality, including avascular necrosis or devascularization of the humeral head.

Conclusions

Glenohumeral dislocation is a rare entity associated with the proximal humerus fracture in children, with an overall incidence in our case series was 2.14%.

Reduction and stabilization of such injury using an external fixator is a suitable choice for pediatric patients that failed closed reduction.