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Fracture-dislocation of the shoulder in a 32-month-old child
Insights
This case report details a rare proximal humeral epiphyseal fracture-separation and dislocation in a young child, potentially due to abuse. Successful surgical reduction and fixation led to a full recovery with normal shoulder function.
Area of Science:
- Pediatric Orthopedics
- Pediatric Trauma
- Child Abuse Detection
Background:
- Proximal humeral epiphyseal injuries are uncommon in children.
- Distinguishing traumatic from abusive injuries is critical in pediatric cases.
Observation:
- A 32-month-old girl presented with signs of a left shoulder injury after a reported fall.
- Radiographs revealed a radial fracture and a dislocated proximal humeral epiphysis.
- Surgical exploration confirmed the humeral head in a subglenoid position with capsular penetration.
Findings:
- The rare injury involved fracture-separation and anterior subglenoid dislocation of the proximal humeral epiphysis.
- Surgical reduction and percutaneous Kirschner wire stabilization were performed.
- Immobilization in a Velpeau cast for 3 weeks facilitated healing.
Implications:
- This case highlights the importance of considering non-accidental trauma in pediatric epiphyseal injuries.
- Prompt diagnosis and surgical intervention can lead to excellent functional outcomes.
- Long-term follow-up is essential to monitor physeal status and humeral growth.
Abstract:
A case of fracture-separation and dislocation of the proximal humeral epiphysis, a rare injury, is reported. The patient, a 32-month-old girl suspected of being an abused child, was reported to have fallen from her crib 2 days earlier. She had a painful, swollen, slightly ecchymotic left shoulder, which she held in the neutral position and refused to move. Radiographs showed a healing, nondisplaced radial fracture and fracture-separation of the proximal humeral epiphysis, which was dislocated into an anterior subglenoid location. Surgery under general anesthesia showed the humeral head to lie in a subglenoid position and the distal fragment of the separated epiphysis to have penetrated the posterior lateral capsule. The reduction was stabilized with a single, percutaneous, smooth Kirschner wire and shoulder immobilized in a Velpeau cast for 3 weeks. At 2 year follow-up, the patient has painless, full range of motion, the epiphysis is open, and the length of the humerous appears normal.