A Case of Proximal Humerus Fracture Dislocation Presenting With Failed Primary Open Reduction and Internal Fixation Followed by Salvage Reverse Total Shoulder Arthroplasty

The treatment of proximal humerus fractures is complex. Factors like fracture pattern, patient age, pre-injury activity level, soft tissue status, and comorbidities play a role in decision-making for non-operative versus operative management. Complications of non-operative vs operative management of proximal humerus fractures include but are not limited to arthrofibrosis, fracture nonunion, and avascular necrosis. We report an unusual case of a 64-year-old female presenting with a three-part proximal humerus fracture dislocation. The patient underwent primary open reduction internal fixation. Twenty-four weeks after open reduction and internal fixation, the patient experienced collapse of the humeral head with intraarticular hardware migration, and she underwent hardware removal. Fifty-two weeks after hardware removal, the patient experienced avascular necrosis of the humeral head, and she underwent salvage reverse total shoulder arthroplasty. There is debate in the current literature on the best management of multi-part proximal humerus fracture-dislocations.