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| IMAGE QUIZ ARCHIVE | ||||||
| Image Quiz | ||
| A Rare Fracture Dislocation of the Humeral Head1 (continued) |
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 Fig. 2 For larger view, click on image |
Answer: Closer examination of the radiograph revealed widening of the intercostal space between the second and third ribs and an outline of pleura around the humeral head. A computed tomographic scan was performed, revealing fracture dislocation of the humerus with intrathoracic displacement of the humeral head. | |
| Discussion | ||
| Intrathoracic dislocation of the humeral head is exceedingly rare. The intrathoracic displacement of the humeral head was not immediately recognized in our patient. The initial appearance of foreshortening of the proximal part of the upper extremity was suggestive of a fracture of the humeral diaphysis. Three physical and radiographic signs should alert the orthopaedist to intrathoracic dislocation of the humeral head: (1) a rigid, abducted upper extremity that appears to be foreshortened; (2) an increase in the intercostal space at the level at which the humeral head is seen on the initial radiograph of the chest; and (3) an outline of pleura around the humeral head. Placement of a chest tube frequently is necessary, and reduction can be facilitated by manipulation of the humeral head through the thoracostomy wound. If the diagnosis is in doubt, a computed tomograpic scan can provide definitive findings. | ||
| References | ||
| 1. Simpson NS, Schwappach JR, Toby EB. Fracture-dislocation of the humerus with intrathoracic displacement of the humeral head. A case report. J Bone Joint Surg Am. 1998;80:889-91. | ||
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