A clinical case of multifocal fracture combining fracture of the head and diaphysis of the humerus

Relevance. According to statistical data, multifocal fractures of the humerus are quite rare, accounting for approximately 6% of all skeletal bone fractures. Fractures of the proximal humerus and diaphysis of the humerus have a bimodal distribution, as they have both high-energy and low-energy mechanisms of injury. The aim of the study is to demonstrate and analyze the technique of surgical treatment of complex fragment fracture of the proximal humerus and diaphysis of the humerus using a clinical case as an example. Object and methods. Patient V., 37 years old on 12.04.2024 sustained an injury to the right humerus as a result of a fall from a bicycle at high speed. He was admitted to the emergency room of the R. R. Vreden Federal State Institution of Medical and Research Centers, where he was diagnosed with a closed splinter fracture of the proximal part and diaphysis of the right humerus with dislocation of the fragments. Results. The present study presents a traumatologic pathology, namely, a complex fragmentary metadiaphyseal fracture combined with a 4-fragment fracture-dislocation of the humeral head with dislocation of the fragments. The radiologic picture of the fracture at different stages of treatment and the technique of surgical intervention with the Philos long plate are described. The period of fusion of this fracture was 6 months. The final functional result was 97 points on the ConstantMurley scale. On the DASH scale - 1 point. When assessing the function of the shoulder joint: flexion – 170 degrees, abduction – 170 degrees, external rotation – 30 degrees, internal rotation – to the level of the lumbar bone. Conclusions. The surgical treatment of fractures involving both the head and diaphysis of the humerus is a subject of debate. The reasons for this are the rarity of this injury and the different mechanism of injury from low-energy to high-energy. Currently, the preference is given to osteosynthesis with the aim of restoring the medial calcaneus of the proximal humerus and reducing the risks of aseptic necrosis of the humeral head.