doi:10.1016/j.jemermed.2008.07.028 Visual Diagnosis in Emergency Medicine AN UNDETECTED HUMERAL FRACTURE COMPLICATING THE MANAGEMENT OF ANTERIOR SHOULDER DISLOCATION IN AN ELDERLY OSTEOPOROTIC PATIENT Jung Ho Park, MD,* Yong Seuk Lee, MD,* Jong Woong Park, MD,* Woong-Kyo Jeong, MD,† Jun Yong Lee, MD,* Jae Kyun Kim, MD,* and Joon Soo Park, MD* *Korea University Ansan Hospital, Ansan, Korea and †Korea University Anam Hospital, Seoul, Korea Reprint Address: Yong Seuk Lee, MD, Department of Orthopaedic Surgery, Korea University Ansan Hospital, 516 Gozan-1-dong, Danwon-gu, Ansan 425-707, Korea INTRODUCTION The shoulder dislocation, or proximal humerus fracture combination, is challenging to the emergency physician, and occurs frequently in elderly osteoporotic patients. Furthermore, reduction may harmfully affect fracture configuration, and complete reduction may be impossible in some situations (1–5). In the elderly, dislocation will often disrupt an already thin or frayed rotator cuff, but rarely affects the glenoid labrum. Combined fractures of proximal humerus can occur, and some 80% of all frac- tures of the proximal humerus are undisplaced (6). Thus, it is important to seek evidence of an undisplaced hu- meral fracture on the pre-reduction radiograph (5,7–9). The authors present a case of undetected humeral frac- ture complicating the management of anterior shoulder dislocation in an elderly osteoporotic patient and de- scribe the treatment course. Figure 1. (A, B) Radiograph showing an initially undetected fracture line at the anatomical neck (black arrow). RECEIVED: 31 May 2008; FINAL SUBMISSION RECEIVED: 25 June 2008; ACCEPTED: 24 July 2008 The Journal of Emergency Medicine, Vol. 40, No. 3, pp. e55– e57, 2011 Copyright © 2011 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$–see front matter e55