Imaging Case of the Week 66

The following left shoulder x-rays are from a 13 year old who has presented with left shoulder pain and reduced movement after falling on his outstretched left hand a few hours ago. What do you observe?

Left shoulder xray

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Left shoulder xray 2

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[peekaboo_link name=”Answer”]Answer[/peekaboo_link] [peekaboo_content name=”Answer”]

The shoulder x-rays show a Salter-Harris Type I fracture of the proximal humeral epiphysis. There is widening of the epiphyseal plate along with abnormal medial angulation.

Proximal humeral epiphyseal fracture

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Proximal humeral epiphyseal fractures:

  • Common between the ages of 11-15.
  • Usually Salter Harris Type I or Type II (which is more common).
  • Proximal humeral growth plate closes between 16-19 years and accounts for 80% of the longitudinal growth of humerus with good remodelling potential. Thus, most injuries are managed conservatively.

Beginners often confuse normal proximal humeral growth plate for a fracture.

This patient was managed conservatively by the specialist.