Fracture-dislocation of the shoulder in a 32-month-old child.

A case of fracture-separation and dislocation of the proximal humeral epiphysis, a rare injury, is reported. The patient, a 32-month-old girl suspected of being an abused child, was reported to have fallen from her crib 2 days earlier. She had a painful, swollen, slightly ecchymotic left shoulder, which she held in the neutral position and refused to move. Radiographs showed a healing, nondisplaced radial fracture and fracture-separation of the proximal humeral epiphysis, which was dislocated into an anterior subglenoid location. Surgery under general anesthesia showed the humeral head to lie in a subglenoid position and the distal fragment of the separated epiphysis to have penetrated the posterior lateral capsule. The reduction was stabilized with a single, percutaneous, smooth Kirschner wire and shoulder immobilized in a Velpeau cast for 3 weeks. At 2 year follow-up, the patient has painless, full range of motion, the epiphysis is open, and the length of the humerous appears normal.