Fractures involving splitting of the humeral head

Splitting fractures of the humeral head are rare; part of the humeral head dislocates and the unfractured part remains attached to the shaft. We repor t eight cases in young patients. In five the diagnosis was made at presenta tion: three had minimal internal fixation using a superior subacromial appr oach, one had a closed reduction and one a primary prosthetic replacement. All five patients regained excellent function with no avascular necrosis at two years, In three the injury was initially unrecognised; two developed a painless bony ankylosis and one is awaiting hemiarthroplasty. It is important to obtain the three trauma radiographic views to diagnose t hese unusual fractures reliably. CT delineates the configuration of the fra cture. In young patients open reduction and internal fixation seems prefera ble to replacement of the humeral head, since we have shown that the head i s potentially viable.