Case reportMultifragmentary dislocated humeral head fracture-A case report of a successful head preserving treatment strategy despite delayed presentation

- Case report of multifragmentary and luxated humeral head fracture treated headpreserving despite delayed surgery (120 h).
- “Avoiding arthroplasty inspite of extrmely high risk of avascular necrosis due to compromised blood supply in luxation oft he humeral head.
- The headpreserving treatment showed excellent functional and radiologic results keeping a high “quality of life level”.
- Divergent from the recommended standard−treatment (trauma arthroplasty) of luxated humeral headsplit fractures in a “delayed situation” a head preserving option should be taken into consideration.

IntroductionHead preserving, delayed osteosynthesis five days after a luxated, multifragmentary humeral head fracture is rarely seen and a challenge for the surgeon.Presentation of caseThis case history describes the case of a 69-year-old female with delayed head preserving treatment of a dislocated multifragmentary humeral head fracture using intramedullary nailing, avoiding a primary trauma arthroplasty after strict refusal of the patient despite poor prognosis and high risk of avascular humeral head necrosis.DiscussionThe treatment of the humeral head fracture is still a matter of debate, the “golden standard” does not exist, especially in the deferred luxated situation. With the use of modern implants head preserving treatment is reasonable and possible. It should therefore always be taken into account as an alternative for arthroplasty.ConclusionExcellent postoperative outcome can be achieved by joint reconstruction eliminating the possible side effects of shoulder endoprosthesis.