Intrathoracic fracture-dislocation of the humerus – case report and literature review

Abstract

Shoulder fracture-dislocations are uncommon. Those associated with intrathoracic dislocation are very rare conditions, resulting from high-energy trauma; usually, the affected limb is in an abduction position. In Brazil, there is only one report of a teenager with displacement of the epiphysis into the chest cavity; the present is the first adult patient report of intrathoracic dislocation of the humerus. The authors present the case of a patient female, aged 56 years, who was hit by motorcycle and thrown approximately 5 meters away. She was rescued on site with thoracic, pelvic, and right upper limb trauma. Her chest was drained due to pneumothorax and multiple fractures of ribs; she was diagnosed with fracture-dislocation in four parts, with intrathoracic dislocation of the humeral head. Displaced forearm bones fracture was also diagnosed; the olecranon, scaphoid, and ischiopubic fractures were not displaced. The patient underwent a joint procedure with a cardiothoracic surgery team to remove the humeral head through thoracotomy and chest drainage; subsequently, a partial arthroplasty of the humerus was performed, with graft from the humeral head and fixation of forearm fractures. Conservative treatment was chosen for the other fractures. After three months, all fractures were healed with gradual functional improvement. The patient remained in physiotherapy and orthopedic monitoring, having been discharged from the thoracic surgery; in a severe depressive episode, the patient committed suicide after 11 months of the trauma.

Encounters between physiotherapists and clients with suicidal thoughts and behaviours: A narrative literature Review

“…Eleven case studies described physiotherapy contact with clients who had physical health conditions and had either made a suicide attempt (Brockington, 2017;Edmunds & Gafner, 2003;Hickey et al, 2017;Lo Pardo et al, 2016;Marusic et al, 2014;Shetye et al, 2014), gone on to complete suicide (Sola & dos Santos, 2017), or had suicidal ideation (Berg, 2011;Cheeks et al, 2014;Miller et al, 2017;Omura & Osorio, 2018). Two of the case studies went beyond a brief mention of the involvement of a physiotherapist with a client with STBs.…”

“…Physiotherapists came into contact with people at various stages of the suicide trajectory. They encountered clients experiencing active suicidal ideation (e.g., McGrath et al, 2020), clients who went on to complete suicide (e.g., Sola & dos Santos, 2017), and clients who previously attempted suicide (e.g., Tepper et al, 2019). Some physiotherapists were directly involved in the treatment of physical conditions that were a sequela of incomplete suicide (e.g., Lo Pardo et al, 2016), while other physiotherapists managed physical health conditions that were not associated with a suicide attempt (e.g., Hickey et al, 2017).…”

Intrathoracic Fracture-dislocation of the Humeral Head:A Case Report and Review of the Literature

“…Intrathoracic fracture-humeral head dislocation has been rarely reported and requires a combination of high-energy trauma and speci c mechanisms. Enumerating the mechanism of injury, most of which are high-energy injuries.We can review including 18 falls from heigh [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18], 7 motor vehicle accidents [19][20][21][22][23][24][25], and 2 were knocked down by motor vehicles [26,27], 2 cases of falling from standing height [28,29], and 1 case of falling from a bicycle [30].…”

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

“…This study investigates a case report of intrathoracic fracture-dislocation of the humeral head. The reviews included falls from height (n=18) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), motor vehicle accidents (n=7) (19)(20)(21)(22)(23)(24)(25), knockdown by motor vehicles (n=2) (26,27), falling from standing height (n=2) (28,29), and falling from a bicycle (n=1) (30).…”