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Avascular necrosis of the humeral head is a complication of displaced and severely comminuted fractures or fracture-dislocations of the proximal humerus. Knight and Mayne1 reported an overall 62.5% incidence of avascular necrosis in patients treated conservatively and operatively. Neer reported 6.5% and 25% incidences of avascular necrosis in three- and four-part fractures, respectively, of the proximal humerus. Resch et al3 reported an 11% incidence in four-part fractures and 0% in three-part fractures.
This article presents a case of avascular necrosis of the humeral head with complete resorption of the proximal humerus after an undisplaced three-part fracture.
CASE REPORT
A 56-year-old woman presented with an undisplaced fracture of the proximal humerus and a displaced fracture of the femoral neck on me left side following a fall from a flight of stairs (Figure 1). Medical history was significant for diabetes mellitus, hypertension, and schizophrenia.
The displaced femoral neck fracture was fixed with cannulated screws, and me undisplaced proximal humeral fracture was treated conservatively in a broad arm sling. Radiographs obtained 3 weeks postinjury revealed satisfactory position of me humeral head with callus formation (Figure J ). Conservative treatment was continued.
While lhe patient was in the rehabilitation ward, cushingoid features were noted and a blood test revealed a high Cortisol level. Dexamethasone (20 mg) suppression brought the Cortisol level back to normal.
Gentle mobilization exercises were started after 4 weeks. The patient reported pain in the same shoulder during mobilization and the physiotherapist noticed instability. Radiographs obtained 3 months postinjury showed resorption of the proximal humerus, leaving a sclerotic osteochondral shell of the head and abundant callus around the distal fragment (Figure I ). The hip fracture was uniting satisfactorily without any evidence of avascular necrosis. Normal inflammatory markers in the blood ruled out the possibility of infection. The diagnosis of Charcot joint also...