Tuesday, July 6, 2010

The Laughing Trauma Patient


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.

 What's his problem? What's your therapeutic plan?

11 comments:

mehrnaz said...

I think it's compressed fx of humeral neck and posterior dislocation of shoulder on both sides.

Arash Safaie said...

any other comment?
any plan?

mehrnaz said...

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

mehrnaz said...

is it correct,dr? please tell us the answer

Arash Safaie said...

u r not right
and I did not learn anything about xray reading in orthopedic rotation, it is mandatory for us.

mehrnaz said...

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!

Arash Safaie said...

Any other idea? What's the problem? What's the management?

N M said...

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.

Arash Safaie said...

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.

mehrnaz said...

so no dislocation?

Arash Safaie said...

so no dislocation.