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Fracture of the Humeral Neck with Intrathoracic Dislocation of the Humeral Head

      Abstract

      Intrathoracic fracture-dislocation of the humeral neck is a rare and easily overlooked clinical entity. We present a case and review of the literature. The objective of this study was to summarize the clinical presentation of this injury and to provide recommendations for initial diagnostic imaging and management. A 68-year-old man presented to the Emergency Department after a fall onto an abducted arm with moderate respiratory distress, mild left shoulder pain, and palpable crepitus over the shoulder and chest wall. Radiographic examination demonstrated the humeral head to be lying within the left hemithorax, devoid of any attachments to the remaining proximal humerus. After initial stabilization, the patient underwent surgical excision of the humeral head and delayed hemiarthroplasty. Careful attention to radiographic studies is required to recognize this injury. Initial management centers on airway management, adjunctive imaging, and treatment of any associated injuries followed by surgical excision and proximal humeral reconstruction.

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      References

        • Harman B.D.
        • Miller N.G.
        • Probe R.A.
        Intrathoracic humeral head fracture-dislocation.
        J Orthop Trauma. 2004; 18: 112-115
        • Glessner J.R.
        Intrathoracic dislocation of the humeral head.
        J Bone Joint Surg Am. 1961; 43: 428-430
        • Patel M.R.
        • Pardee M.L.
        • Singerman R.C.
        Intrathoracic dislocation of the head of the humerus.
        J Bone Joint Surg Am. 1963; 45: 1712-1714
        • Kaar T.K.
        • Rice J.J.
        • Mullan G.B.
        Fracture-dislocation of the shoulder with intrathoracic displacement of the humeral head.
        Injury. 1995; 26: 638-639
        • Hardcastle P.H.
        • Fisher T.R.
        Intrathoracic displacement of the humeral head with fracture of the surgical neck.
        Injury. 1981; 12: 313-315
        • Wirth M.A.
        • Jensen K.L.
        • Agarwal A.
        • Curtis R.J.
        • Rockwood Jr, C.A.
        Fracture-dislocation of the proximal part of the humerus with retroperitoneal displacement of the humeral head: a case report.
        J Bone Joint Surg Am. 1997; 79: 763-766
        • Eberson C.P.
        • Ng T.
        • Green A.
        Contralateral intrathoracic displacement of the humeral head.
        J Bone Joint Surg Am. 2000; 82: 105-108