Ann Thorac Surg 2008;86:1029. doi:10.1016/j.athoracsur.2007.10.095
© 2008 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Simultaneous Lung and Spine Impalement From a Fractured Humerus After Blunt Trauma
Françoise Le Pimpec-Barthes, MD, PhDa,*,
Davy Ngabou, MDa,
Thierry Della-Siega, MDb,
David Marrache, MDc
a Department of Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
b Department of Orthopaedic Surgery, Georges Pompidou European Hospital, Paris, France
c Department of Reanimation, Georges Pompidou European Hospital, Paris, France
* Address correspondence to Dr Le Pimpec-Barthes, Department of Thoracic Surgery, Georges Pompidou European Hospital, 20 rue Leblanc, Cedex 15, Paris, 75908, France (Email: francoise.le-pimpec-barthes{at}hop.egp.ap-hop-paris.fr).
Blunt trauma to the shoulder resulting in humeral fracture and dislocation with intrathoracic displacement of the humeral head is extremely rare [1–3]. We observed a still more rare complex humeral fracture with an in-place humeral head but intrathoracic displacement of humeral bone fragments.
A 32-year-old male motorcyclist traveling at high speed underwent blunt trauma with impaction of the shoulder. Respiratory failure required rapid intubation and ventilatory support. Hemodynamic status was stable. A computed tomographic scan was obtained, which demonstrated a humeral fragment penetrating the lung (Fig 1A) and a second fragment impaled in the body of the fifth thoracic vertebra (Fig 1B). Moderate hemothorax and pneumothorax with subcutaneous emphysema were also noted (Fig 1B). A right anterior minithoracotomy video-assisted approach showed a humeral metaphysis fragment traversing the chest wall and the right upper lobe as far as the mediastinum (Fig 2A). The humeral fragment was removed, which disclosed a pulmonary artery branch injury, which was immediately controlled and sutured. The fragment measured 8 cm (Fig 2B). The humeral fragment in the spine was strongly impacted and could not be extracted. The thoracic procedure was followed by shoulder osteosynthesis. The patient was discharged from the intensive care unit on day 20, faring well and without neurologic sequellae. Such migration of humerus fragments is probably related to violent and direct impact to the upper limb while in mild abduction. This kind of traumatic injury is likely associated with immediate death, which may account for why it is so rarely seen.
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References
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- Wiesler ER, Smith AM, Shilt JS. Humeral head fracture-dislocation into the thoracic outlet: case report and review of the literature J Shoulder Elbow Surg 2004;13:576-579.[Medline]
- Kaar TK, Rice JJ, Mullan GB. Fracture-dislocation of the shoulder with intrathoracic displacement of the humeral head Injury 1995;26:638-639.[Medline]
- Harman BD, Miller NG, Probe RA. Intrathoracic humeral head fracture-dislocation J Orthop Trauma 2004;18:112-115.[Medline]
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