Hamed Rym, Zoubli Aymen, Ghazali Hanène, Mekki Imen, Maaref Amel, Jerbi Siwar
Emergency Department- Charles Nicolle Teaching Hospital- Tunis-Tunisia- Faculty of Medicine of Tunis.
Emergency Department- Ben Arous Regional Teaching Hospital- Tunis - Tunisia- Faculty of Medicine of Tunis.
Tunis Med. 2023 Nov 5;101(11):852-854.
Severe trauma is a frequent condition encountered in Emergency department (ED) in which vital prognosis can easily be engaged. This condition could be responsible for unusual injuries occurrence. Emergency physician must be aware of these situations where adequate management is urgently required. We report a case of e 45-year-old patient who was admitted to the ED after a high velocity road traffic accident resulting in multiple injuries and fracture dislocation and migrating humeral head into intra thoracic position.
We report the clinical case of a patient aged 45 years without medical history admitted to the ED after being involved in a high-velocity road traffic accident. On clinical presentation, the patient was dyspneic and desaturated on ambient air room, he presented moreover clinical signs of blunt right shoulder trauma and deformation of the 2 thighs. Final screening of injuries by radiological and a tomographic exams retained a polytrauma status with fracture dislocation and migration of humeral head, homolateral hemothorax and double femur fracture. Patient was managed by multidisciplinary surgical approaches. Discusssion et conclusion: We illustrated by this case a very rare post trauma condition represented by a fracture dislocation of the humeral head resulting in an intrathoracic migration and a homolateral hemothorax. This diagnosis was reported only a few times by the literature within last decades and management suffers from lack of treatment guidelines, which remain team-dependent. At the very early stage of management and before surgical step, emergency physician must be aware of the possibility of this clinical condition with evolution into some threatening clinical presentations with specific management.
严重创伤是急诊科常见的病症，在此情况下生命预后极易受到影响。这种情况可能导致不寻常的损伤发生。急诊医生必须了解这些迫切需要适当处理的情况。我们报告一例45岁患者，在高速道路交通事故后被送往急诊科，导致多处受伤、骨折脱位以及肱骨头移入胸腔内。
我们报告一例45岁无病史患者的临床病例，该患者在高速道路交通事故后被送往急诊科。临床表现为，患者在室内空气中呼吸困难且血氧饱和度降低，此外还表现出右肩部钝性创伤和双侧大腿变形的临床体征。通过放射学和断层扫描检查对损伤进行最终筛查，确定为多发伤，伴有肱骨头骨折脱位和移位、同侧血胸以及双侧股骨骨折。患者接受了多学科手术治疗。讨论与结论：我们通过该病例展示了一种非常罕见的创伤后病症，表现为肱骨头骨折脱位导致胸腔内移位和同侧血胸。在过去几十年中，这种诊断在文献中仅被报道过几次，并且治疗缺乏指导方针，治疗仍依赖于团队。在治疗的早期阶段以及手术步骤之前，急诊医生必须意识到这种临床情况有可能演变为一些具有特定治疗方法的威胁性临床表现。
