Revascularization of the humeral head. A report of two cases of fracture-dislocation of the shoulder.

Two cases of fracture-dislocation of the shoulder are reported in which the humeral heads were found at open reduction to be without soft tissue attachments. The patients were followed up clinically and radiologically and by technetium-99m scintigraphy for at least two years. In the case of a three-part fracture-dislocation, revascularization of the humeral head was complete three months after surgery, whereas the humeral head in the four-part fracture-dislocation did not appear totally revascularized scintigraphically until nine months after surgery. Radiologic signs of avascular necrosis of the humeral head were not encountered. Both patients were pain-free, and the shoulders functioned well, although suboptimal ranges of motion were recorded. It was concluded that open reduction and internal fixation is indicated initially rather than conservative treatment and before use of a prosthetic device is considered, in view of the acceptable results obtained. It appears that revascularization of the humeral head occurs by creeping substitution.