Case Report
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2018; 6(15): 1029-1035
Published online Dec 6, 2018. doi: 10.12998/wjcc.v6.i15.1029
Injury to the axillary artery and brachial plexus caused by a closed floating shoulder injury: A case report
Yu-Chun Chen, Zhen Lian, Yan-Na Lin, Xin-Jia Wang, Guan-Feng Yao
Yu-Chun Chen, Zhen Lian, Xin-Jia Wang, Guan-Feng Yao, Department of Orthopedics, the Second Affiliated Hospital, Shantou University Medical College, Shantou 515041, Guangdong Province, China
Yan-Na Lin, Department of Rehabilitation, Shantou Central Hospital, Shantou 515041, Guangdong Province, China
Author contributions: Yao GF and Wang XJ designed the report; Chen YC, Lian Z and Lin YN collected the patient’s clinical data; Chen YC and Lian Z analyzed the data; Lian Z wrote the paper; Chen YC and Lian Z contributed equally to this work.
Informed consent statement: Consent was obtained from patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare no potential conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared according to the CARE checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guan-Feng Yao, PhD, Chief Doctor, Department of Orthopedics, the Second Affiliated Hospital, Shantou University Medical College, Dongxiabei Road, Shantou 515041, Guangdong Province, China. yao_guanfeng@hotmail.com
Telephone: +86-754-83141092 Fax: +86-754-88346543
Received: July 4, 2018
Peer-review started: July 5, 2018
First decision: October 4, 2018
Revised: November 4, 2018
Accepted: November 14, 2018
Article in press: November 15, 2018
Published online: December 6, 2018
Processing time: 155 Days and 19.4 Hours
Abstract
BACKGROUND

A floating shoulder may be associated with catastrophic neurovascular injury and requires a multidisciplinary approach for its management. To maximize the likelihood of good patient outcomes, this unique injury pattern should be recognized in patients as early as possible. This can be difficult to achieve, however, as there are currently few reports of floating shoulder in the literature, meaning that associated neurovascular injuries may be overlooked.

CASE SUMMARY

We present here a rare case of floating shoulder with axillary artery injury in a 34-year-old woman. The patient complained of pain and numbness of her left upper limb after losing control of her motorcycle on a highway and falling from the vehicle 2 h ago. No blood pressure reading could be obtained from her left upper limb and no blood oxygen readings could be obtained from any of her left fingers. Computed tomography angiography and duplex ultrasonography revealed interruption of blood flow through the axillary artery, with distal flow being maintained through collateral arteries. The clinical diagnosis including fracture of the left proximal humerus, the left clavicle, and the left scapula, left axillary artery rupture, and left brachial plexus injury. We successfully performed open reduction and internal fixation of the fracture and vascular repair. The patient showed satisfactory recovery that was observed during 4-mo follow-up.

CONCLUSION

Emergency surgery can be an effective therapeutic option for the closed floating shoulder with catastrophic axillary artery injury.

Keywords: Floating shoulder injury; Axillary artery injury; Brachial plexus injury; Complications of floating shoulder; Management of floating shoulder; Clavicle fracture; Case report

Core tip: A floating shoulder with catastrophic neurovascular injury may be overlooked, as there are currently few reports in the literature. This case report describes that brachial plexus and axillary artery injury by the distal fragment of the clavicle in a closed floating shoulder, and we successfully performed open reduction and internal fixation of the fracture and vascular repair.