A torque induced iatrogenic fracture of the humeral shaft in proximal humeral fracture plating – A case report and biomechanical perspectives

Introduction Proximal humerus fractures are common amongst the elderly and osteoporotic cohorts. Common treatment methods include proximal locking plates. In this case, we describe an iatrogenic fracture of the proximal humeral shaft during screw insertion under power. Similar cases have not been described previously in open reduction and internal fixation of a proximal humerus fracture. Further, we focus particularly on precautionary measures that aim to avoid such complications that may lead to considerable morbidity. Case presentation We describe a case of a 65 year old osteoporotic female who underwent open reduction internal fixation of a proximal humerus fracture complicated by an unusual iatrogenic humeral fracture at the level of insertion of the distal screw, likely secondary to inserting the proximal locking screws under power. Conclusion In this case, we explore the possible factors leading to the fracture and precautionary measures to avoid them. The rate of iatrogenic intraoperative fractures are likely underreported and have not been described in open reduction and internal fixation of an existing fracture. The underlying factors that may predispose to such complications have not been previously described in similar cases. This case serves as a warning of an unanticipated complication and describes the potential biomechanical factors involved.
Highlights • Proximal humerus fractures are common in the elderly and osteoporotic cohorts. • Iatrogenic fractures intraoperatively during open reduction internal fixation have not been reported in orthopedic trauma. • Care should be taken to avoid excessive energy/torque at screw sites while using electric drivers. • The biomechanical precautions during fixation should be visited and more extensively described to avoid similar incidents.