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. 2013 Jul 7;7(1):24.
doi: 10.1186/1754-9493-7-24.

Fracture of the shoulder girdle in multiply injured patients - an imperative for a high level of suspicion for associated neurovascular injuries

Senat Krasnici  1 , Jörg Schmidt, Kolja Reimann, Wolfgang Ertel, Tobias Topp
Affiliations

Fracture of the shoulder girdle in multiply injured patients - an imperative for a high level of suspicion for associated neurovascular injuries

Senat Krasnici et al. Patient Saf Surg. .

Abstract

Background: The combination of a bony injury to the shoulder girdle and damage to the brachial plexus and the subclavian vessels is a rare finding. The cases of this combined injury pattern described in the literature are most notably reported in multiply-injured patients after high velocity trauma.

Findings: Three cases were admitted to our hospital after motorcycle accidents resulting in a combination of severe bony injuries to the shoulder girdle, to the subclavian artery and a lesion to the brachial plexus. Based on these three clinical cases the patterns of injury, as well as primary and secondary treatment approaches are presented.

Conclusion: The early detection of these injuries can be difficult in given acute, life threatening injuries addressed first in these multiply injured patients. A high level of suspicion, in conjunction with standardized ATLS based institutional protocols for secondary and tertiary survey, should increase the likelihood of a timely detection and early management of these rare but potentially devastating injuries.

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Figures

Figure 1
Figure 1
MRI of infraclavicular level. Abnormal exposure of the right brachial plexus, indicating a partial injury.
Figure 2
Figure 2
Polytrauma CT scan. Extravasation of contrast agent in left subclavian artery indicating rupture.
Figure 3
Figure 3
CT-3D-reconstruction of shoulder girdle. Visualization of displaced scapula fracture on the left side. Note also the extravasation of contrast agent and the missing presentment of the ipsilateral subclavian artery.
Figure 4
Figure 4
MRI of left shoulder girdle. Tear of the left brachial plexus.
Figure 5
Figure 5
Algorithm for the management of injuries to the subclavian vessels and brachial plexus in multiply-injured patients in hemodynamically stable (a) and unstable (b) condition. (API = Arterial Pressure Index).
See this image and copyright information in PMC

References

    1. Kaiser R, Mencl L, Haninec P. Injuries associated with serious brachial plexus involvement in polytrauma among patients requiring surgical repair. Injury. 2012. in press. - PubMed
    1. Giuffre JL, Kakar S, Bishop AT, Spinner RJ, Shin AY. Current concepts of the treatment of adult brachial plexus injuries. J Hand Surg Am. 2010;35:678–688. doi: 10.1016/j.jhsa.2010.01.021. - DOI - PubMed
    1. Rumball KM, Da Silva VF, Preston DN, Carruthers CC. Brachial-plexus injury after clavicular fracture: case report and literature review. Can J Surg. 1991;34:264–266. - PubMed
    1. Zelle BA, Pape HC, Gerich TG, Garapati R, Ceylan B, Krettek C. Functional outcome following scapulothoracic dissociation. J Bone Joint Surg Am. 2004;86:2–8. - PubMed
    1. Feliciano DV. Management of peripheral arterial injury. Curr Opin Crit Care. 2010;16:602–608. doi: 10.1097/MCC.0b013e32833f3ee3. - DOI - PubMed

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