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

Abstract

BackgroundThe 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.FindingsThree 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.ConclusionThe 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.

Clavicle fractures

“…Acute vascular injuries may present with an expanding supra-/subclavicular swelling or hematoma, a widened mediastinum, reduced/absent pulse, or a varying degree of limb ischemia and are often associated with nerve injury (Graham et al, 1980;Jeray, 2007;Katras et al, 2001). A thorough neurovascular examination is necessary to avoid missing these injuries (Jeray, 2007;Krasnici et al, 2013). Pulmonary injuries can present with dyspnea, painful breathing, subcutaneous air, abnormal breath sounds, reduction/absence, or vesicular murmur (Tjoumakaris et al, 2011;Geraci et al, 2007).…”