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 Table of Contents  
CLINICAL IMAGE
Year : 2017  |  Volume : 7  |  Issue : 2  |  Page : 29

Old post-traumatic malunited humeral head fracture with dislocated shoulder: Delayed effect of an underestimated fall


Enrico and Enrica Sovena Foundation, Via Asmara, 00199 Rome, Italy

Date of Web Publication30-Jul-2018

Correspondence Address:
Cosma Calderaro
Enrico and Enrica Sovena Foundation, Via Asmara, 00199 Rome
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsr.Int_J_Stud_Res_12_17

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  Abstract 


We present a case of a delayed effect of an old humeral head fracture with dislocated shoulder diagnosed an year after a low energy fall. After the injury, the patient experienced only mild pain and avoided radiological evaluation. The clinical and radiological evaluation showed a malunion of an underestimated displaced humeral head fracture with severe secondary arthritic changes.

Keywords: Dislocated shoulder, humeral head fracture, malunion


How to cite this article:
Calderaro C. Old post-traumatic malunited humeral head fracture with dislocated shoulder: Delayed effect of an underestimated fall. Int J Stud Res 2017;7:29

How to cite this URL:
Calderaro C. Old post-traumatic malunited humeral head fracture with dislocated shoulder: Delayed effect of an underestimated fall. Int J Stud Res [serial online] 2017 [cited 2019 Oct 15];7:29. Available from: http://www.ijsronline.net/text.asp?2017/7/2/29/237938



A 63-year-old, otherwise healthy, Caucasian male, bricklayer by profession, presented to our clinic for the evaluation of chronic left shoulder pain which started an year ago following a fall from short height in his home. The patient experienced mild pain that was relatively relieved with over the counter medications. He avoided radiological evaluation including X-rays. He continued to work despite the mild reduction in range of motion (ROM) at his left shoulder for a couple of months until he started experiencing pain at his affected shoulder joint along with severe restriction of ROM (2 months before presentation). On examination, there was severe reduction of both active and passive ROM at the affected shoulder associated with mild pain, and a positive Neer test and Jobe test. An X-ray of his left shoulder demonstrated an old displaced humeral head fracture healed in varus position, dislocated shoulder, and severe secondary arthritic changes of the head of the humerus and the glenoid [Figure 1]a and [Figure 1]b. The patient was referred for evaluation for total joint replacement.
Figure 1: X-rays in anteroposterior view with the arm in abduction (a) and adduction (b), show an old malunited displaced humeral head fracture, healed in varus position, dislocated head of the humerus, and severe secondary arthritic changes involving the humeral head and glenoid

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Pain is almost always the most common presenting symptom in most fractures secondary to restriction in ROMs and other associated symptoms[1]. Our case of the shoulder fracture lacked typical symptoms at presentation. The fracture was articular with a severe varus displacement that resulted in secondary arthritic changes of the shoulder joint. With no previous shoulder imaging for comparison, it was unlikely to comment if the arthritic changes at his left shoulder were present before the fall or untreated displaced humeral head fracture was the cause of delayed worsening. Prompt evaluation is necessary, especially in elderly age group following a fall that is associated with mild degree of pain to rule out any bony discontinuity and optimization of outcomes[2].

Consent

Written informed consent was obtained from the patient for publication of this case report and accompanying images.

Competing Interests

The author declares that he has no competing interests.

Funding

Sources of Funding: None.



 
  References Top

1.
Maier D, Jaeger M, Izadpanah K, et. al. Proximal humeral fracture treatment in adults. J Bone Joint Surg Am 2014;96(3):251-61.  Back to cited text no. 1
    
2.
Mansat P, Bonnevialle N. Treatment of fracture sequelae of the proximal humerus: anatomical vs. reverse shoulder prosthesis. Int Orthop 2015;39(2):349-54.  Back to cited text no. 2
    


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