Sola Junior Wilson Carlos, Santos Paulo Sérgio Dos
Hospital XV, Curitiba, PR, Brazil.
Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, PR, Brazil.
Rev Bras Ortop. 2017 Feb 5;52(2):215-219. doi: 10.1016/j.rboe.2017.01.005. eCollection 2017 Mar-Apr.
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.
肩部骨折脱位并不常见。那些与胸内脱位相关的情况是非常罕见的病症，由高能创伤导致；通常，患侧肢体处于外展位。在巴西，仅有一例青少年骨骺移位至胸腔的报告；本文是首例肱骨胸内脱位的成年患者报告。作者介绍了一名56岁女性患者的病例，她被摩托车撞击并被抛出约5米远。她在现场获救，伴有胸部、骨盆和右上肢创伤。因气胸和多根肋骨骨折，她的胸腔进行了引流；她被诊断为四部分骨折脱位，伴有肱骨头胸内脱位。还诊断出前臂骨移位骨折；鹰嘴、舟骨和耻骨坐骨支骨折未移位。患者与心胸外科团队进行了联合手术，通过开胸手术和胸腔引流取出肱骨头；随后，进行了肱骨部分关节成形术，取自肱骨头的移植物并固定了前臂骨折。对其他骨折选择了保守治疗。三个月后，所有骨折均愈合，功能逐渐改善。患者一直在接受物理治疗和骨科监测，已从胸外科出院；在一次严重的抑郁发作中，患者在创伤11个月后自杀。
