Fracture-dislocation of proximal humerus in a young child: A case report.

Abstract

Introduction: Proximal humerus Salter-Harris type II fractures combined with ipsilateral shoulder dislocation in children are extremely rare injuries. Therefore, the best prescribed treatment has not yet been established.

Case presentation: A case of a 3-year-old boy who sustained an epiphyseal separation of the right proximal humerus (Salter-Harris type II) and an ipsilateral anterior dislocation of the glenohumeral joint following a road traffic accident. Closed reduction of both injuries under the C-arm intensifier failed. Open reduction was performed through an anterior deltopectoral approach with two 1.6 mm Kirschner wires fixation. Outcome was good with full range of motion of the shoulder.

Clinical discussion: Traumatic proximal humeral physis fracture associated with shoulder dislocation is a rare and severe injury. Optimal management is still debated, non operative or surgical treatment (open or closed reduction with osteosynthesis) being advocated as the most preferred approach. Open reduction should be performed in patients whose closed reduction has failed, due to soft tissue entrapment.

Conclusion: Proximal humerus fractures combined with ipsilateral shoulder dislocation in children under five years are rare but do occur. Open reduction followed by pinning is a good therapeutic option with good outcome when closed reduction failed.