Arthroscopic Treatment of Isolated Tophaceous Gout of the Knee: A Rare Case Report.

INTRODUCTION

Proximal humerus fractures are uncommon in children, accounting for <5% of pediatric fractures, with glenohumeral dislocation being an even rarer occurrence. These injuries are challenging due to the complex shoulder anatomy and the risk of growth disturbances, as the proximal humeral physis contributes ~80% of humeral growth. While many fractures can be managed conservatively, severe displacement or associated dislocations, such as Neer-Horwitz Type IV fractures, may require surgical intervention. Treatment options include K-wires, elastic stable intramedullary nailing, and plate fixation, with K-wires offering a less invasive alternative. We present a case of a 12-year-old boy with a Neer-Horwitz Type IV fracture-dislocation, successfully treated with closed reduction and K-wire fixation, demonstrating the effectiveness of this technique in preserving growth potential while achieving stability.

CASE REPORT: We present the case of a 5-year-old right-hand dominant girl who sustained a severely displaced proximal humerus fracture with anterior glenohumeral dislocation after falling from a train berth. She landed on her outstretched left hand, resulting in severe pain, deformity, and loss of arm function. Radiographs and CT imaging confirmed a Neer-Horwitz Type IV fracture with significant displacement and varus angulation. Closed reduction and percutaneous K-wire fixation were performed under general anesthesia using the Kapandji and Jyoctiky maneuver, achieving satisfactory fracture alignment and joint reduction. Postoperatively, the arm was immobilized with a Dynaplast bandage, allowing for early pendulum exercises. The patient was discharged on post-operative day two with maintained reduction and proper K-wire positioning. This case highlights the efficacy of minimally invasive techniques for complex pediatric fractures, preserving growth potential while restoring joint stability.

CONCLUSION

This case highlights the effectiveness of closed reduction and K-wire fixation in managing complex pediatric proximal humerus fracture dislocations. The technique provides adequate stability while minimizing iatrogenic physeal damage, leading to excellent functional outcomes. However, each case should be approached individually, considering factors such as age, fracture pattern, and surgeon experience.