Entrapped long head of biceps tendon in pediatric proximal humerus fracture dislocation: A case report and review of the literature

Abstract

Introduction and importance Combined proximal humerus fracture and glenohumeral dislocation in the pediatric population is extremely rare, with only few reports of such cases been reported. We review all cases of combined proximal humerus fracture and glenohumeral dislocation in the pediatric population and present a case of left proximal humerus fracture dislocation in a healthy 5-year-old girl. Case presentation A 5-year-old girl fell from 2 m height and landed on her left shoulder where she started to complain from severe left shoulder pain, inability to move her left shoulder and bruising. She was diagnosed at our facility to have left proximal humerus fracture combined with glenohumeral dislocation and was treated with open reduction, K-wires fixation and immobilization in a shoulder cast. Clinical discussion Traumatic proximal humeral fracture associated with glenohumeral dislocation is a rare presentation in pediatric age group. This type of fracture is usually managed by closed reduction and casting, with a minority being managed with open reduction. Indications for surgical intervention are open fractures, severely displaced fractures, fractures that are associated with neurovascular compromise, or irreducible fracture due to soft tissue obstacles. Conclusions A high index of suspicion is required to diagnose such injuries along with appropriate radiographic evaluation. We recommend open reduction with K-wires fixation for irreducible combined proximal humeral fracture and glenohumeral dislocation.

Bone cemented K-wire fixation versus elastic stable intramedullary nailing fixation of paediatric proximal humerus fractures: A prospective cohort study

“…Percutaneous pinning techniques (PP) and ESIN techniques are the most common methods. [13,[18][19][20][21] Binder et al [10] treated 40 children (40 PPHFs) using percutaneous pinning. They obtained 36 excellent, 2 average, and 2 poor results based on the Constant-Murley Score.…”

“…A myriad of fixation methods for PPHFs can be utilized, the managements are mainly performed by Kirschner wires (K-wires), Elastic Stabilized Intramedullary Nail (ESIN), or screws and plate. [13,[18][19][20][21] Open reduction and internal fixation using a plate and screws system was rarely used in PPHFs because iatrogenic injuries to the proximal humerus were the major concern. [22] The intramedullary nailing is a commonly fixation method and always used for the shaft fractures.…”

Management of traumatic fracture–dislocation of the shoulder in children: A systematic review of published case reports

“…A few such cases have been reported in the literature. 22 In the event of vague history, the possibility of NAI should be suspected when there is no high-energy trauma involved. Two cases were reported by Nicastro 6 and Young 21 where they recommended conducting a thorough examination and skeletal survey to exclude NAI.…”

“…Azevedo, 7 Joghun, 9 Jin 10 and Omari 22 treated shoulder fracture–dislocation by open reduction with fixation as they failed to achieve reduction. Fannouch 19 and Ikram 20 managed to achieve anatomical reduction of the fracture as well as dislocation by closed method using intramedullary fixation technique as described by Metaizeau in 1976.…”