Humeral Shaft Fracture with Ipsilateral Anterior Shoulder Dislocation and Posterior Elbow Dislocation: A Case Report and Review of the Literature.

Abstract

Fractures of the humeral shaft are rarely complicated by ipsilateral shoulder or elbow dislocation. While the majority of isolated humeral shaft fractures can be treated nonoperatively, polytrauma, neuromuscular disease, and pathologic fractures are often indications for operative intervention1,2. Injuries resulting in concomitant joint dislocation may be associated with functionally adverse outcomes3. Since first reported in the literature in 1940, there have been twenty-three reports in eighteen papers of humeral shaft fractures associated with anterior shoulder dislocation4. There have been even fewer reports of humeral shaft fractures with ipsilateral posterior shoulder dislocation5,6 or ipsilateral elbow dislocation7. We present a case of an extremely rare injury involving a humeral shaft fracture with ipsilateral shoulder and elbow dislocation. To our knowledge, the simultaneous dislocation of both joints in association with an ipsilateral humeral shaft fracture has been reported only once in the literature7. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-six-year-old black man arrived at our level-I trauma center. He had been struck by a forklift while trying to save a two-year-old child from being hit by the machine. He sustained a left frontal intraparenchymal subarachnoid hemorrhage with associated facial and orbital fractures. Radiographs obtained in the trauma bay and physical examination revealed a fracture of the midshaft of the right humerus with an ipsilateral anterior glenohumeral dislocation and a posterior elbow dislocation (Figs. 1-A and 1-B). Anteroposterior (AP) ( Fig. 1-A ) and lateral ( Fig. 1-B ) radiographs of the right humerus and elbow demonstrating a comminuted oblique midshaft fracture with lateral apex angulation and posterior displacement of the distal fragment. Also evident are the anterior glenohumeral dislocation ( Fig. 1-A ) and the posterior elbow dislocation ( Fig. 1-B ). Fig. 1-A Fig. 1-B While the patient was in the trauma bay, we first turned our attention to the closed joint reductions. We employed general anesthesia to relax the patient adequately. In order to take tension off of the median, ulnar, and radial nerves distally, and to give us a stable and …