Abstract
A 57-years-old gentleman left hand dominant working as a manual labourer in a factory fell from ladder on 16/12/2017, on initial assessment (Full ATLS protocol) there was no injury besides his left upper limb/arm. BP: 139/80 - HR: 70/min - O2 saturation: 97% on R/A - RR: 18 - Temperature 36.1.
Highlights
The fracture healed within 4 months and patient had nerve conduction studies performed, which revealed damage at the level of the cords with affection of posterior cord, on second nerve conduction study last May showed evidence of ongoing re-innervations in the upper part of the posterior cord muscles but less so on the lower elements
In complex anterior fracture-dislocations of the proximal humerus, a Neer three- or four part fracture is combined with disruption in the anteroinferior soft-tissue envelope [1], Owing to the devascularisation of the humeral head as a result of the disruption of its capsular attachments, there is a high risk of osteonecrosis or nonunion following this injury [2]
The fracture healed within 4 months and patient had nerve conduction studies performed on two occasions the last on 11.05.2018 which was reported as: Positive sharp waves with polyphasic recruitment for the triceps in the order of 60%
Summary
In complex anterior fracture-dislocations of the proximal humerus, a Neer three- or four part fracture is combined with disruption in the anteroinferior soft-tissue envelope [1], Owing to the devascularisation of the humeral head as a result of the disruption of its capsular attachments, there is a high risk of osteonecrosis or nonunion following this injury [2]. There was swelling and deformity of the left shoulder and arm with intact sensation of the ulnar nerve but diminished sensation of the median and radial nerve with wrist drop and a weak hand grip. The fracture site was carefully exposed as well as the radial nerve which was found to be impaled by the sharp distal end of the proximal fragment. The main diaphyseal fracture fragments were reduced and fixed with two 4.5 mm interfragmentary cortical screw with compression effect. The fracture healed within 4 months and patient had nerve conduction studies performed on two occasions the last on 11.05.2018 (posterior cord/triceps/supinator/EDC/ECR/EIP screening) which was reported as: Positive sharp waves with polyphasic recruitment for the triceps in the order of 60%. On last visit on 10th August there is a recovery of the wrist extensors grade IV and to some extent of the finger extensors Grade III, recovery of sensation of the hand
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