Shieh Andrew, McMichael Jessica C, Knudsen-Robbins Chloe, Brindis Seth L, Heyming Theodore W
Children's Hospital of Orange County, Orange, CA, USA.
University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Case Rep Orthop. 2022 Feb 4;2022:8673859. doi: 10.1155/2022/8673859. eCollection 2022.
Proximal humerus fractures with severe medial displacement of the humeral head are rare in adults and especially so in children. Concomitant vascular/neurovascular injury is even more uncommon but must be considered as the associated complications can carry significant morbidity. We present a case of a 12-year-old transported to the ED after a mountain bike accident in which she lost control and hit a cement wall, injuring her left upper extremity (LUE). Despite a normal vascular/sensory exam, imaging demonstrated a left comminuted proximal humerus fracture with the humerus displaced medially into the thoracic inlet as well as concern for left subclavian vessel injury. Given the possibility of vascular injury and the severe humeral head displacement, she was taken to surgery with orthopedic and vascular surgical teams. Although surgical exploration did not reveal vascular injury, this case underlines the importance of maintaining a high index of suspicion for neurovascular injury with such fractures as prompt intervention may reduce the likelihood of complications. This case also underscores the need for further research into the management of pediatric proximal humerus fractures in early adolescence.
成人肱骨头严重向内侧移位的肱骨近端骨折很少见，儿童更是如此。合并血管/神经血管损伤则更为罕见，但必须考虑到，因为相关并发症可能导致严重的发病率。我们报告一例12岁儿童，在山地自行车事故后被送往急诊科，她在事故中失去控制，撞到水泥墙，导致左上肢受伤。尽管血管/感觉检查正常，但影像学显示左肱骨近端粉碎性骨折，肱骨头向内侧移位至胸廓入口，同时担心左锁骨下血管损伤。鉴于存在血管损伤的可能性以及肱骨头严重移位，她被送往手术室，由骨科和血管外科团队进行手术。尽管手术探查未发现血管损伤，但该病例强调了对此类骨折的神经血管损伤保持高度怀疑指数的重要性，因为及时干预可能降低并发症的发生率。该病例还强调了进一步研究青春期早期儿童肱骨近端骨折治疗方法的必要性。
