Intrathoracic displacement of a fractured left humeral head

Case contributed by Dr Fakhry Mahmoud Ebouda

Presentation

Chest pain, deformity with shortness of breath after a high-speed motor vehicle accident.

Patient Data

Age: 55 years.
Gender: Male

Comminuted displaced fracture of the left humeral head.

Communited fracture of the left humerus. The humeral head is displaced in left upper hemithorax abutting the aortic arch. Comminuted fracture of the left clavicle, left transverse process of T1 and the 1st and 2nd ribs. Suspected fractures are seen involving 3rd ,4th and 5th ribs. Soft tissue haematoma with surgical emphysema involving the left shoulder and upper chest wall. Moderate haemothorax is on the left side. Patchy shadowing is seen involving the left lung more marked in upper lobe most likely representing contusions.

Intra-operative photos during thoracotomy.

The left humeral head fragments after extraction from the left hemithorax.

Case Discussion

The patient presented to ER after lateral impaction during a high speed motor vehicle accident. He was consciousness, tachypneaic and had a deformity of the left shoulder. Peripheral pulses and nerves are intact except the axillary nerve could not be assessed due to severe pain. After the CT, the patient was transferred to the ICU for further management of hameodynamics. An anterolateral thoracotomy was performed to extract the migrated head of the left humerus that lay adjacent to the aortic arch. A 4-5 cm left apical pulmonary laceration was repaired to haemostasis. After a full recovery the patient underwent split thickness graft on the left hand, left clavicle and olecranon fixation and was transferred to another centre for hemiarthroplasty.

Although extremely rare, intrathoracic displacement of a fractured humeral head may be initially missed due to other serious injuries in the region, may be a life threatening condition and in need of urgent surgical intervention.

The case is courtesy of Dr Mounther Al Daradkah, Chest Surgery Consultant, RCMC

Thanks to Dr Hatem Mahmoud Hanafi for supplying the photo.

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Case information

rID: 28053
Case created: 7th Mar 2014
Last edited: 13th Mar 2016
Inclusion in quiz mode: Included

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