Albert Sandeep, Jayashankar Viswanath, Gouse Mohamad
Department of Orthopaedics, Christian Medical College, Unit 1, Vellore 632004, India.
Case Rep Emerg Med. 2014;2014:689157. doi: 10.1155/2014/689157. Epub 2014 Jul 22.
Scapulothoracic dissociation involves varying degree of discontinuity of the upper extremity from its truncal attachment. An eighteen-year-old male presented to the accident and emergency department following a motor vehicle accident where he was hit by a four wheeler while riding a two wheeler. He had tenderness and deformity over the left clavicle and the left humerus. He was unable to perform active wrist and finger dorsiflexion. A CT subsequently revealed a grade 2 splenic laceration. The splenic laceration was treated conservatively. As his general condition improved, he was gradually weaned off the ventilator and his left upper limb neurology was reassessed. He had isolated radial nerve palsy with an otherwise intact brachial plexus. He underwent internal fixation of the clavicle and the humerus. At 4 months after injury the EMG/NCV report showed signs of renervation of the radial nerve, and the fracture progressed to an uneventful union. This prior unreported triad of scapulothoracic dissociation with ipsilateral clavicular and humeral fractures may represent a parody. An apparent increase in the severity of skeletal injury was associated with a paradoxical decrease in the severity of neurovascular injury. We report this case to create awareness among orthopedic surgeons and emergency physicians about the clinical presentation of such injuries.
肩胛胸壁分离涉及上肢与其躯干附着处不同程度的连续性中断。一名18岁男性在骑两轮摩托车时被四轮车撞到，随后被送往急诊室。他的左锁骨和左肱骨有压痛和畸形。他无法主动进行腕关节和手指背伸。随后的CT显示2级脾破裂。脾破裂采用保守治疗。随着他的一般状况改善，他逐渐停用呼吸机，并重新评估其左上肢神经功能。他患有单纯性桡神经麻痹，臂丛神经其他部分完好。他接受了锁骨和肱骨的内固定。受伤4个月后，肌电图/神经传导速度报告显示桡神经有再生迹象，骨折顺利愈合。这种先前未报道的肩胛胸壁分离合并同侧锁骨和肱骨骨折的三联征可能具有一定特点。骨骼损伤严重程度的明显增加与神经血管损伤严重程度的反常降低相关。我们报告此病例以提高骨科医生和急诊医生对此类损伤临床表现的认识。
