Clinical Challenge: Humeral Lesions discovered after running accident

  • Fig 1. Minimally displaced fracture through the anatomical neck of the humerus.

  • Fig 2. Extensive osteolysis of the humeral head and neck

  • Fig 3. MRI showed a locally aggressive, destructive lesion involving the entire humeral head, neck, and proximal shaft, with no extension into the glenoid fossa.

  • Fig 4. Open reduction internal fixation (ORIF)/cement grafting (internal rotation view).

  • Fig 5. ORIF/cement grafting (anteroposterior view).

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Ms. E is a healthy, 19-year-old white woman who injured her right shoulder after falling while running. At the emergency department, she was told that she had a proximal humerus fracture.

Ms. E's arm was placed in a standard sling, and she was instructed to make an appointment with an orthopedic surgeon in the next few weeks, but she deferred orthopedic evaluation for six weeks while she prepared to move to another state.

New x-rays taken by her primary-care clinician revealed a minimally displaced proximal humerus fracture with a large osteolytic lesion of the humeral head, neck and proximal shaft. The patient underwent a CT scan that day and was referred to the orthopedic department for further evaluation.

View images and learn more about the case below, or click here to read a longer version of the article.

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