Major Assessment Unit
SE/B06/003: In and out but should you shake it all about?
Man sitting
Back to St Emlyn's Reception

Q1. I would take bets that you described a fracture to the proximal humerus extending into the greater tuberosity with an associated dislocation. Am I right? If so it is because you have made the cardinal mistake of not looking at two views of the same injury. Look at the next film shown below. It clearly shows that the humerus is adjacent to the humeral head.

What we have here is a subluxation of the humeral head due to a large intrarticular haematoma. This is most commonly seen in the elderly and I have seen a number of doctors attempt (unsuccesfully) a reduction of these injuries under sedation. The degree of subluxation seen here is much more common in the elderly.

Q2. This injury was treated with a Broad arm sling and referred to frracture clinic with an intention of conservative management. There was discussion of whether it would be advisable to aspirate the joint, but this was not advocated by our local orthopaedic service.

Simon Carley