Intrathoracic Fracture Dislocation in a Patient with Proximal Humerus Fracture
A 58-year-old woman who had fallen down stairs, resulting in a non-reconstructable fracture of the proximal humerus was transferred to our hospital for shoulder replacement surgery. The patient also suffered from thoracic injury including ipsilateral fractures of multiple ribs and hematopneumothorax with a chest tube in place. After deltopectoral approach to the right shoulder the humeral head could not be identified intraoperatively. Uncomplicated reverse total shoulder arthroplasty was then performed. Subsequent CT scan confirmed the suspicion of intrathoracic dislocation of the humeral head (Figure). The fragment of the humeral head located in the thorax was removed by video-assisted thoracoscopic surgery without complications. Proximal humeral fractures with intrathoracic dislocation of the separated fragment are extremely rare. Standard preoperative x-ray diagnostic is usually not sufficient to detect this dislocation, therefore our case underlines the importance of a preoperative CT scan. Although the literature contains a few descriptions of individual cases in which the intrathoracic fragment of the humeral head was left in situ with good outcome, most authors recommend early removal.
PD Dr. med. Paola Kappel, Dr. med. Sebastian Imach, Prof. Dr. med. Arasch Wafaisade, Orthopädie, Unfallchirurgie und Sporttraumatologie, Krankenhaus Köln-Merheim, Universität Witten/Herdecke, Köln; firstname.lastname@example.org
Conflict of interest statement: Prof. Wafaisade has received lecture fees from Stryker and from Smith & Nephew and reimbursement of travel costs from Stryker, Smith & Nephew, DePuy Synthes, and Arthrex. The remaining authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare.
Cite his as: Kappel P, Imach S, Wafaisade A: Intrathoracic fracture dislocation in a patient with proximal humerus fracture. Dtsch Arztebl Int 2021; 118: 578. DOI: 10.3238/arztebl.m2021.0065