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Imaging at 2 years post-trauma: (a and b) Radiograph showing a mixed sclerotic and lytic lesion in the humeral head with a congruent articular surface, (c) short tau inversion recovery coronal magnetic resonance imaging (MRI) image, and (d) T2-weighted gradient echo axial MRI image showing aserpiginous, geographic lesion in the humeral head with a normal contour of articular surface with a partial tear of subscapularis and a torn and retracted long head of biceps tendon.
Source publication
Introduction
Osteonecrosis of the humeral head is not a very common entity. It is usually associated with comminuted proximal humerus fractures. We report a rare case of osteonecrosis of humeral head after anterior shoulder dislocation without any fracture of the proximal humerus.
Case Report
We report a case of a 24-year-old male who sustained a...
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Citations
... 15 La necrosis avascular de la cabeza del húmero es una complicación posible en pacientes con fracturas y luxaciones; 16 no obstante, su incidencia después de una luxación de hombro no ha sido determinada, posiblemente debido a que puede presentarse en cualquier momento de la evolución de la lesión, lo que dificulta su diagnóstico. De hecho, a partir de nuestra búsqueda de literatura sobre el tema, identificamos reportes de caso de necrosis avascular como complicación de luxación anterior de hombro, 16,17 mas no de luxación posterior. Teniendo en cuenta que el tiempo de seguimiento del paciente de este reporte de caso fue corto, aún no podemos descartar la posibilidad de ocurrencia de dicha complicación. ...
Introducción. La luxación traumática posterior de hombro es una lesión rara; además, su ocurrencia bilateral es aún menos frecuente y se asocia a convulsiones o electrochoques. Presentación del caso. Hombre de 25 años que fue atendido en el Servicio de Urgencias de un hospital de segundo nivel de atención de Popayán (Colombia) luego de chocar en una motocicleta contra un automóvil. Con base en los signos clínicos y los hallazgos en las radiografías y la tomografía axial computarizada, se confirmó el diagnóstico de luxación posterior de hombro bilateral, por lo que se realizó reducción cerrada. La rehabilitación se inició a la tercera semana del procedimiento y se realizó seguimiento mensual de la funcionalidad de los hombros utilizando la escala Disabilities of the Arm, Shoulder and Hand (DASH) abreviada. La recuperación fue satisfactoria y, al año de seguimiento, no presentó ninguna limitación funcional ni cambios radiográficos sugestivos de artrosis o necrosis ósea. Conclusión. La luxación posterior traumática de hombro es una condición poco frecuente y usualmente pasada por alto, por lo que debe tenerse en cuenta como diagnóstico diferencial en pacientes con trauma de hombro, con el fin de realizar un tratamiento oportuno y evitar secuelas funcionales graves.
... They range from non-surgical or conservative treatment to surgical options such as central decompression, total shoulder arthroplasty, or reverse total shoulder arthroplasty (RTSA). The latter is considered the treatment of choice in the late stages (3, 4, or 5) of the disease [18], as was the case with the patient mentioned. ...
Osteonecrosis of the humeral head is seen in rare cases of anterior shoulder dislocations. There are many different surgical procedures that have been developed to repair inveterate anterior glenohumeral dislocation. Reverse shoulder arthroplasty (RSA) is a type of surgery that has been shown to be very effective in patients with cuff tear arthropathy.
A 63-year-old female came to our service with an inveterate glenohumeral dislocation. We identified the osteonecrosis of the humeral head and decided to treat her with a reverse shoulder arthroplasty.
Osteonecrosis following a glenohumeral dislocation is a rare condition. Treatment with a reverse shoulder arthroplasty allows a fast recovery, good functional results, and a better quality of life.
... 15,16 The glenohumeral dislocation associated with the fracture intensifies the circulatory severity of the proximal humerus as the displaced fragment has circulatory insufficiency due to the direct injury of the nutrient arteries of this segment and scarce soft tissue insertion. 17 As most fracture-dislocations occur in a younger population, orthopedic surgeons should make a major effort to restore congruence to these injuries. We consider that lower pressure determined by locked plates, the concept of biological fixation, the use of minimally invasive techniques, indirect reductions, age below 50 years, and anatomical and stable reductions provide a substantial effect in protecting the vascular supply of the fractured humeral head. ...
Objective:
To predict the risk of osteonecrosis (ON) according to the Neer and Hertel et al. classification for surgically treated proximal humeral fractures after at least one year of follow-up.
Methods:
This is a retrospective, cross-sectional, and observational cohort study. A total of 44 patients, 16 (36.36%) men and 28 (63.63%) women, with a mean age of 61.36 years, participated in this study. Lesions were categorized according to Neer and Hertel's classifications, considering the preoperative prognosis for ON. After at least a year of follow-up, patients were reassessed. Data were evaluated using IBM SPSS Statistics®.
Results:
A total of three patients (6.8%) developed osteonecrosis. Comparisons showed no statistically significant difference, but we observed a superior association of osteonecrosis for the Hertel classification than that of Neer.
Conclusion:
Both classifications showed a similar ability to identify patients at low risk of developing ON. New studies with a greater number of participants and sample homogeneity may intensify the value of the evaluation of clinical applicability and predictive capacity of the studied classifications with greater significance and correlation. Level of Evidence III, Case Control Study.
