Fracture-Dislocation of the Humerus with Intrathoracic Displacement of the Humeral Head. A Case Report*

Of the glenohumeral fracture-dislocations that have been described in the orthopaedic literature, those involving intrathoracic displacement of the humeral head are the least common3. We describe here the case of an adolescent patient who sustained a fracture-dislocation of the proximal part of the humerus with intrathoracic displacement of the humeral head when she was struck by a motor vehicle. A fourteen-year-old girl was running across the road when she was struck on her left side by a motor vehicle that was traveling at a speed of approximately thirty-five miles (fifty-six kilometers) per hour. She was thrown about twenty feet (six meters) and landed on her right side. When she was seen in the emergency department at the University of Kansas Medical Center, she had pain in the right shoulder and upper extremity and she resisted attempts to move the extremity. The vital signs included a pulse of seventy-two beats per minute, a blood pressure of 130/70 millimeters of mercury (17.33/9.33 kilopascals), a temperature of 36.6 degrees Celsius, and a respiratory rate of eighteen breaths per minute. Physical examination revealed the right arm to be rigidly held in 80 degrees of abduction and 70 degrees of internal rotation. The proximal portion of the upper extremity appeared to be foreshortened. There was no neurovascular deficit, and the skin was intact. The lungs were clear on auscultation. The patient was also found to have a minimally displaced fracture of the tibial plateau. Physical examination was difficult because the patient was combative and obese. An anteroposterior radiograph of the chest, made with portable equipment, was interpreted as demonstrating a posterior subscapular glenohumeral dislocation …