Entrapped long head of biceps tendon in pediatric proximal humerus fracture dislocation: A case report and review of the literature

Introduction and importance: Combined proximal humerus fracture and glenohumeral dislocation in the pediatric population is extremely rare, with only few reports of such cases been reported. We review all cases of combined proximal humerus fracture and glenohumeral dislocation in the pediatric population and present a case of left proximal humerus fracture dislocation in a healthy 5-year-old girl. Case presentation: A 5-year-old girl fell from 2 m height and landed on her left shoulder where she started to complain from severe left shoulder pain, inability to move her left shoulder and bruising. She was diagnosed at our facility to have left proximal humerus fracture combined with glenohumeral dislocation and was treated with open reduction, K-wires fixation and immobilization in a shoulder cast. Clinical discussion: Traumatic proximal humeral fracture associated with glenohumeral dislocation is a rare presentation in pediatric age group. This type of fracture is usually managed by closed reduction and casting, with a minority being managed with open reduction. Indications for surgical intervention are open fractures, severely displaced fractures, fractures that are associated with neurovascular compromise, or irreducible fracture due to soft tissue obstacles. Conclusions: A high index of suspicion is required to diagnose such injuries along with appropriate radiographic evaluation. We recommend open reduction with K-wires fixation for irreducible combined proximal humeral fracture and glenohumeral dislocation.