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Fractures involving splitting of the humeral head

T. J. S. Chesser, FRCS (Tr & Orth), Specialist Registrar in Orthopaedic Surgery1; I. J. Langdon, FRCS (Tr & Orth), Specialist Registrar in Orthopaedic Surgery2; C. Ogilvie, MD, Consultant Orthopaedic Surgeon3; P. P. Sarangi, MD, Consultant Orthopaedic Surgeon1; and A. M. Clarke, FRCS(Orth), Consultant Orthopaedic Surgeon3

1 Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW, UK.
2 Avon Orthopaedic Centre, Southmead Hospital, Westbury-on-Trym, Bristol BS10 5NB, UK.
3 Taunton and Somerset Hospital, Musgrove Park, Taunton, Somerset TA1 5DA, UK.

Correspondence should be sent to Miss I. J. Langdon.

Splitting fractures of the humeral head are rare; part of the humeral head dislocates and the unfractured part remains attached to the shaft. We report eight cases in young patients. In five the diagnosis was made at presentation: three had minimal internal fixation using a superior subacromial approach, one had a closed reduction and one a primary prosthetic replacement. All five patients regained excellent function with no avascular necrosis at two years. In three the injury was initially unrecognised; two developed a painless bony ankylosis and one is awaiting hemiarthroplasty.

It is important to obtain the three trauma radiographic views to diagnose these unusual fractures reliably. CT delineates the configuration of the fracture. In young patients open reduction and internal fixation seems preferable to replacement of the humeral head, since we have shown that the head is potentially viable.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General