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Salter-Harris type III fracture-dislocation of the proximal humerus
1Department of Orthopaedic Surgery, Hospital for Joint Diseases Orthopaedic Institute, New York, NY 10003, USA.
Insights
This study details a rare Salter-Harris type III proximal humerus fracture in a child. Despite initial devascularization, surgical repair led to excellent long-term shoulder function and recovery.
Area of Science:
- Pediatric Orthopedics
- Pediatric Trauma
- Skeletal Development
Background:
- Salter-Harris type III fractures of the proximal humerus are uncommon pediatric injuries.
- This case involves an anterior fracture-dislocation, a specific and rare presentation.
- Management of physeal injuries requires careful consideration of growth plate preservation.
Observation:
- A 10-year-old boy sustained a Salter-Harris type III anterior fracture-dislocation of the proximal humerus.
- The injury was treated with open reduction and internal fixation.
- Bone scintigraphy demonstrated initial devascularization of the humeral head epiphysis, followed by revascularization over two years.
Findings:
- The patient achieved full shoulder range of motion, complete pain relief, and symmetrical arm strength at two-year follow-up.
- Previous reports of similar fractures also indicate favorable early clinical outcomes.
- Despite the temporary loss of blood supply to the epiphyseal fragment, a positive long-term outcome was observed.
Implications:
- This case suggests that even with transient devascularization, Salter-Harris type III proximal humerus fractures can have excellent prognoses with appropriate surgical management.
- It highlights the potential for revascularization and functional recovery in pediatric physeal fractures.
- Further research into the long-term outcomes and optimal management strategies for these rare injuries is warranted.
Abstract:
Salter-Harris type III fractures of the proximal humerus are rare injuries. We report a Salter-Harris type III anterior fracture-dislocation of the proximal humerus in a 10-year-old boy that was open reduced and internally stabilized. A bone scan performed during the initial hospitalization and at 2-year follow-up revealed devascularization and subsequent revascularization of the humeral head. At 2-year follow-up, the patient had full motion of the shoulder, no pain, and arm strength equal to that of the contralateral side. Four cases of Salter-Harris type III fractures of the proximal humerus have been previously reported; good early clinical outcomes were obtained in all. Despite devascularization of the epiphyseal fragment, excellent clinical outcomes may result.