Intrathoracic fracture-dislocation of the humeral head: A case report and review of the literature
Vol. 23 No. 8 (2021), Case reports
Vol. 23 No. 8 (2021)

Intrathoracic fracture-dislocation of the humeral head: A case report and review of the literature

Case reports
https://doi.org/10.32592/ircmj.2021.23.8.1248
Published 2021-08-22 — Updated on 2021-09-15
Ruifeng Yang
Department of Orthopaedics, Lishui Central Hospital, Lishui, Zhejiang, 323000, China.
Shuhua Lan
Department of Orthopaedics, Lishui Central Hospital, Lishui, Zhejiang, 323000, China.
Quanzhou Wu
Department of Orthopaedics, Lishui Central Hospital, Lishui, Zhejiang, 323000，China.
Fang Ye
Department of Orthopaedics, Lishui Central Hospital, Lishui, Zhejiang, 323000，China.
Jifei Ye
Department of Orthopaedics, Lishui Central Hospital, Lishui, Zhejiang, 323000，China.
Shuming Huang
Department of Orthopaedics, Lishui Central Hospital, Lishui, Zhejiang, 323000，China.
Panpan Xie
Department of Orthopaedics, Lishui Central Hospital, Lishui, Zhejiang, 323000，China.
Hailin Xing
Department of Orthopaedics, Lishui Central Hospital, Lishui, Zhejiang, 323000，China.
Chong Wang
Department of Orthopaedics, Lishui Central Hospital, Lishui, Zhejiang, 323000，China.

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Keywords

Arthroplasty
Humeral fractures
Intrathoracic dislocation
High-energy trauma
Thoracic injuries

How to Cite

Yang, R. ., Lan, S. ., Wu, Q. ., Ye, F. ., Ye, J. ., Huang, S. ., Xie, P. ., Xing, H. ., & Wang, C. (2021). Intrathoracic fracture-dislocation of the humeral head: A case report and review of the literature. Iranian Red Crescent Medical Journal, 23(8). https://doi.org/10.32592/ircmj.2021.23.8.1248
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Abstract

Background: Intrathoracic displacement of a humeral head fracture is extremely rare. Only slightly more than 30 cases have been reported in this regard. Since few cases have been reported, there is no consensus on how to treat this injury. The etiology, injury mechanism, related lesions, and treatment of the injury are diverse. Case presentation: A 73-year-old female presented with multiple fractures of the left ribs, bilateral lung contusions, extensive emphysema of the anterior and posterior chest wall, massive left hemopneumothorax, fracture-dislocation of the proximal humerus, and intrathoracic displacement of the humeral head. The patient was sent to the operating room for emergency thoracotomy surgery. The head of the humerus was confirmed to be completely removed from the thoracic cavity during the operation. After discussion with the orthopedic surgeon, the humeral head was discarded considering avascular necrosis; moreover, open reduction and internal fixation were not performed. The orthopedic surgery team performed reverse shoulder arthroplasty three weeks later. During follow-up, the patient’s shoulder was free from pain, and its range of movement included 110° flexion, 70° abduction, 35° external rotation, and 50° internal rotation. Conclusion: Intrathoracic displacement of the humeral head due to proximal humeral fracture is a very rare and serious trauma that requires multidisciplinary treatment. Considering the extremely high risk of humeral head necrosis, actively removing broken bone fragments of the humeral head in the early stage is recommended, and we advocate for shoulder arthroplasty for elderly patients. Detailed preoperative evaluations and individualized operation plans should be made to achieve the best effect..

https://doi.org/10.32592/ircmj.2021.23.8.1248
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