What do you think of this happy motorcycle rider?
He was a 26 y/o rider who was ejected from motorcycle in MVA.
His primary survey was normal. He didn't complain of any pain and just complained decrease of bilateral shoulders ROM.
In examination there were both sided mild tendeness over humeral head and decrease of shoulder ROM in all directions bilaterally. N/V was normal.
Here are his AP shoulder radiogaraphies.
11 comments:
I think it's compressed fx of humeral neck and posterior dislocation of shoulder on both sides.
any other comment?
any plan?
oops! I think I was completely wrong, now that I watch the x-rays more carefully I think it can be ant. dislocation( the humerus head inf. to the coracoid process) with fx of the greater tuberority.just imagine what would happen if I were to manage this patient! ;0 I didn't pass orthopaedics rotation, it was optional, so I have lots of difficulty interpreting x-rays
is it correct,dr? please tell us the answer
u r not right
and I did not learn anything about xray reading in orthopedic rotation, it is mandatory for us.
what's the Dx then,dr?
the head of the humerus is also compressed against the glenoid rim, isn't it?
my mind is obsessed by these X-rays!
Any other idea? What's the problem? What's the management?
Well I agree with the tuberosity fracture, but I'm not sure about the dislocation; may be the cause of the displacement of the humerus is unopposed force of the deltoid muscle.
Considering the management, I would ask for an orthopedic consultation, for I think it would need a surgical repair.
Diagnosis is:
Bilateral greater tuberosity fx of humerus without any dislocation.
With regards to less than 1 cm displacement and less than 45 degree angulation it may treated conservatively with shoulder sling.
But as there is bilateral injury it maybe preferable to consult orthopedic surgeon.
so no dislocation?
so no dislocation.
Post a Comment