The Pucker Sign: A Rare Finding Associated With Humeral Neck Fracture
A 43 year old Caucasian female presented to the Emergency Department with a left
shoulder injury after falling from a “mini-barstool” which she was standing on to reach an
overhead shelf.
The mechanism was unclear as the patient did not remember what happened.
She did remember the fracture occurring and the onset of severe pain with inability to move her
arm immediately after the fall.
Her past history was remarkable for mental health issues and
illicit drug use including crack cocaine and marijuana.
Physical examination was remarkable for the patient holding the involved
extremity in an adducted, internally rotated position by supporting it with the contralateral
upper extremity.
Additionally, puckering of the skin along
with ecchymoses was noted over the proximal anterior upper extremity.
Radiographs of the injury demonstrated a comminuted fracture of the surgical neck of the left
hummers. Orthopedic evaluation of the patient was accomplished in the emergency
department.
Over the next several weeks several emergency department visits occurred for uncontrolled
pain and medication refill requests.
Fractures of the proximal humerus are reportedly the second most common fracture
type of the upper extremity and the third most common fracture after hip
and distal radius fractures in patients older than 65 years.
Most often, non-unions of the proximal humerus involve two-part fractures at the surgical neck
region.2,3 This patient’s fracture based on the Neer classification
system of proximal humeral fractures was a comminuted two
part fracture of the surgical neck.
Emerg Med Open J. 2016; 1(4): 115-117. doi: 10.17140/EMOJ-1-118
