RESUMO
Distal humeral periprosthetic fractures below intramedullary nail devices are complex and challenging to treat, in particular due to the osteopenic/porotic nature of bone found in these patients. Fixation is often difficult to satisfactorily achieve around the intramedullary device, whilst minimising soft tissue disruption. Descriptions of such cases in the current literature are very rare. We present the case of a midshaft humeral fracture treated with a locking compression plate that developed a nonunion, in a 60-year old female. This went on to successful union after exchange for an intramedullary humeral nail. Unfortunately, the patient developed a distal 1/5th humeral periprosthetic fracture, which was then successfully addressed with a single-contoured, extra-articular, distal humeral locking compression plate (Synthes) with unicortical locking screws and cerclage cables proximally around the distal nail tip region. An excellent postoperative range of motion was achieved.
RESUMO
Coracoid fractures are rare injuries in themselves. Even rarer are isolated fractures of the coracoid in the skeletally immature patient. Due to the low numbers of these fractures, there is no true consensus on how to treat them. We report two cases of an isolated fracture of the coracoid. Case A is a 13-year-old boy who sustained the coracoid fracture following a skiing injury; case B is a 15-year-old boy who fell onto the right shoulder during a wheelbarrow race at school. Initial radiographs in case A suggested a displaced fracture; however, a CT scan taken after a short period of conservative treatment showed minimal displacement. In case B both the radiographs and CT scan showed no displacement. Both injuries were treated conservatively and united uneventfully with a full return to function. We advocate conservative management for these injuries in the skeletally immature patient.
