Intrathoracic Fracture-Dislocation of the Humeral Head: A Case Report

Abstract

Fracture-dislocation of the humeral head into the thoracic cavity is a rare injury. We present one such case in a 70-year-old woman. She presented with a 4-part fracture-dislocation of the proximal humerus, with displacement of the humeral head into the thoracic cavity. She had no signs of acute distress or hemodynamic instability. She underwent hemiarthroplasty of the right shoulder, but the humeral head fragment could not be removed. At 27-month follow-up, the patient had limited mobility of her right shoulder due to axillary nerve palsy but no pain or intrathoracic complications. In the absence of intrathoracic complications, the removal of the humeral head may not be necessary.

Intrathoracic dislocation of the humeral head accompanied by polytrauma: How to treat it ?

“…Abellan et al [6] presented a case of a 70-year-old woman who underwent hemiarthroplasty of the right shoulder; however, the humeral head fragment could not be removed. At the 27-month follow-up, the patient had limited mobility of her right shoulder due to axillary nerve palsy, but no pain or intrathoracic complications.…”

“…[15] Shoulder hemiarthroplasty is the treatment of choice for shoulder fracture. [6,2,8,9] Maroney et al [11] first presented a case of a 67-year-old woman after a fall down one flight of stairs. After emergent extrication of the intrathoracic humeral head and proximal medial shaft, the patient underwent delayed shoulder reconstruction with a reverse total shoulder arthroplasty and allograft augmentation.…”

Intrathoracic Displacement of a Fractured Humeral Head due to Blunt Trauma

“…Sudden force may make the humeral head into the thoracic cavity. 1,2,4,5) A fractured humeral head may be detected by direct chest X-ray, and a subsequent chest CT scan with intravenous contrast is helpful to confirm the diagnosis and evaluate the blood vessels; 5) however, the appropriate treatment method has not yet been established. 2,4) Even though the need for removal of the fractured humeral head from the pleural cavity has been questioned, various approaches to remove fractured bone through a thoracotomy or thoracoscopy have been reported.…”

“…1,2,4,5) A fractured humeral head may be detected by direct chest X-ray, and a subsequent chest CT scan with intravenous contrast is helpful to confirm the diagnosis and evaluate the blood vessels; 5) however, the appropriate treatment method has not yet been established. 2,4) Even though the need for removal of the fractured humeral head from the pleural cavity has been questioned, various approaches to remove fractured bone through a thoracotomy or thoracoscopy have been reported. [1][2][3][4][5] Proximal humeral fractures can be treated by several methods such as open reduction and internal fixation and re-attachment of the rotator cuff tendons to the humeral shaft.…”

“…However, the appropriate treatment method remains unclear, and some of the reported cases were not undergo surgery to remove the humeral head. 1,2) Here, we report the successful management of an intrathoracic fracture-dislocation of the humeral head due to blunt trauma through a one-stage operation.…”