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Patient presents with right shoulder discomfort discomfort after a FOOSH type injury. Limited ROM is noted. 

No prior surgeries,  carcinoma  or corticosteroid/opioid regimen reported.

What do you see?

Cortical incongruity is present on the medial side of the right surgical neck. Extensive HBO is seen medial and pseudo- periosteal reaction is seen at the lateral humeral aspect. These are radiographic findings of prior trauma with subsequent malunion/non-union. Oops!

DISCUSSION: Nonunion most commonly occurs following surgical neck fractures. (1)Surgical neck nonunion can occur as a result of different factors. One of the most common is distraction or motion at the fracture site. Distraction can occur due to soft tissue interposition or, much less commonly, with the use of a hanging arm cast. Restoration of this fracture is difficult surgically. (1) Motion at the surgical neck fracture site is often due to (1) inadequate immobilization, (2) too early mobilization, and (3) inadequate fixation.

REFERENCES:

  1. https://musculoskeletalkey.com/complications-of-proximal-humeral-fractures/
  2.  https://www.orthobullets.com/trauma/1015/proximal-humerus-fractures#:~:text
  3.  https://coreem.net/core/proximal-humerus-fracture