Impalement injuries of the shoulder: a case report with literature review

Impalement injuries of the shoulder: a case report with literature review

Authors

  • Marco Scaglia Università di Verona
  • Stefano Negri Università di Verona https://orcid.org/0000-0003-2218-6654
  • Gianmarco Pellizzari Università di Verona
  • Andrea Amarossi Università di Verona
  • Davide Pasquetto Università di Verona
  • Elena Manuela Samaila Università di Verona
  • Tommaso Maluta Università di Verona
  • Eugenio Vecchini Università di Verona
  • Matteo Ricci Università di Verona
  • Roberto Valentini Università di Verona
  • Bruno Magnan Università di Verona

Keywords:

Shoulder impalement, penetrant trauma, foreign body, surgical management, shoulder function

Abstract

The management of penetrating skeletal extremity trauma is a clinical challenge even for experienced surgeons. While the treatment of associated vascular injuries should be prioritized, there is still a lack of evidence regarding the management of foreign bodies in case of bone fractures or neurological injuries.

Here we present a case of impalement of the right proximal humerus with a construction steel rod. The 54-year-old man was successfully treated without vascular, neurological, and thoracic sequelae.

A review of the current literature about the most appropriate extrication sequences and soft tissue reconstruction following massive foreign body injuries was carried out.

References

Gonzalez-Urquijo M, Zambrano-Lara M. Broken Knife Blade Completely Penetrating the Humerus: A Case Report and Literature Review. Bull Emerg Trauma. 2020;8(3):202-204. doi: 10.30476/BEAT.2020.85769

David E. Manthey, MD and Bret A. Nicks, MD, Penetrating Trauma To The Extremity, The Journal of Emergency Medicine, Vol 34, n.2, pp 187-193, 2008, doi:10.1016/j.jemermed.2007.03.038

Manthey DE, Nicks BA. Penetrating trauma to the extremity. J Emerg Med. 2008;34(2):187-93.

Ronald M. Stewart el al, Advance Trauma Life Support, Student Manual tenth edition, 2018

Anderson RJ, Hobson RW 2nd, Padberg FT Jr, Swan KG, Lee BC, Jamil Z, et al. Penetrating extremity trauma: identification of patients at high-risk requiring arteriography. J Vasc Surg. 1990;11(4):544-8.

Sakran JV, Mehta A, Fransman R, Nathens AB, Joseph B, Kent A, Haut ER, Efron DT. Nationwide trends in mortality following penetrating trauma: Are we up for the challenge? J Trauma Acute Care Surg. 2018 Jul;85(1):160-166. doi: 10.1097/TA.0000000000001907

G. Whittaker, J. Norton, J. Densley, D. Bew, Epidemiology of penetrating injuries in the United Kingdom: a systematic review, Interantion Journal of Surgery, 2017

Dorlac WC, DeBakey ME, Holcomb JB, Fagan SP, Kwong KL, Dorlac GR, Schreiber MA, Persse DE, Moore FA, Mattox KL. Mortality from isolated civilian penetrating extremity injury. J Trauma. 2005 Jul;59(1):217-22. doi: 10.1097/01.ta.0000173699.71652.ba.

J.T. Kuwahara, A. Kord, C.E.Ray jr, Penetrating Extramity Trauma Endovascular versus Open Repair? Semin Intervent Radiol 2020;37:55-61

Chad G. Ball MD, Penetrating nontorso trauma: the extremities, Can J Surgery, August 2015, DOI: 10.1503/cjs.005815

Sise MJ, Shackford SR. Peripheral vascular injury. In: Trauma, 7th edition. Mattox, Moore & Feliciano. 2014;816-49

Abboud JA, Wiesel B, Tomlinson D, Ramsey M. Intraosseous stab wound to the arm. Am J Orthop (Belle Mead NJ). 2008;37(3):52–4

A.Khajuria, L.Geoghegan, Y.Solberg, D. Reissis, A. Jain, M. Ives, J. Simmons, G. Lawton, S. Hettiaratchy, Pelective non-operative management for penetrating extremity trauma - a paradigm shift in management? Journal of Plastic, Reconstructive & Aesthetic Surgery, 2 January 2018, doi: 10.1016/j.bjps.2018.05.030

Newton EJ, Love J. Acute complications of extremity trauma. Emerg Med Clin North Am. 2007 Aug;25(3):751-61, iv. doi: 10.1016/j.emc.2007.06.003. Emerg Med Clin North Am. 2007 Nov;25(4). PMID: 17826216

E. Tacconelli, E. Carrara, F. Mazzaferri, M. Conti, M. Sibiani, A. Schimmenti, G. Fontana, B. Magnan, E. Polati et al., Linee Guida di Profilassi Chirurgica e Terapia Antibiotica Empirica in Ortopedia e Traumatologia, Azienda Ospedaliera Universitaria Integrata Verona, 2019

Edward J. Skinner; Christopher A. Morrison, Wound Foreign Body Removal, StatPearls, 2021

Gonzalez RP, Falimirski ME. The utility of physical examination in proximity penetrating extremity trauma. Am Surg 1999;65: 784–9

Frykberg ER, Dennis JW, Bishop K, Laneve L, Alexander RH. The reliability of physical examination in the evaluation of penetrating extremity trauma for vascular injury: results at one year. J Trauma 1991;31:502–11

Dennis JW, Frykberg ER, Veldenz HC, Huffman S, Menawat SS. Validation of nonoperative management of occult vascular injuries and accuracy of physical examination alone in penetrating extremity trauma: 5- to 10-year follow up. J Trauma 1998;44:243–52.

Espinosa GA, Chiu JC, Sammett EJ. Clinical assessment and arteriography for patients with penetrating extremity injuries: a review of 500 cases with the Veterans Affairs West Side Medical Center. Mil Med 1997;162:19–23.

Frykberg ER, Schinco MA. Peripheral vascular injury. In: Moore EE, Feliciano DV, Mattox KL, eds. Trauma, 5th edn. New York: McGraw-Hill; 2004:969 –1002

Fields CF, Latifi R, Ivatury RR. Brachial and forearm vessel injuries. Surg Clin North Am 2002;82:105–14.

Yichi Xu, Wenjing Xu, Aiyuan Wang, Haoye Meng, Yu Wang,, Shuyun Liu, Rui Li, Shibi Lu, Jiang Peng, Diagnosis and treatment of traumatic vascular injury of limbs in military and emergency medicine, A systematic review, Medicine (2019) doi: 10.1097/MD.0000000000015406

Smith AA, Ochoa JE, Wong S, Beatty S, Elder J, Guidry C, McGrew P, McGinness C, Duchesne J, Schroll R. Prehospital tourniquet use in penetrating extremity trauma: Decreased blood transfusions and limb complications. J Trauma Acute Care Surg. 2019 Jan;86(1):43-51. doi: 10.1097/TA.0000000000002095. PMID: 30358768

Sabrina Pieroni, Bryan R. Foster, Stephan W. Anderson, Jennifer L. Kertesz, James T. Rhea, Jorge A. Soto, Use of 64-Row Multidetector CT Angiography in Blunt and Penetrating Trauma of the Upper and Lower Extremitites, RadioGraphigs, May-June 2009, doi: 10.1148/rg.293085517

Zarkadas PC, Throckmorton TW, Steinmann SP. Neurovascular injuries in shoulder trauma. Orthop Clin North Am. 2008 Oct;39(4):483-90, vii. doi: 10.1016/j.ocl.2008.06.005. PMID: 18803978

Kaiser R, Waldauf P, Ullas G, Krajcová A. Epidemiology, etiology, and types of severe adult brachial plexus injuries requiring surgical repair: systematic review and meta-analysis. Neurosurg Rev. 2020 Apr;43(2):443-452. doi: 10.1007/s10143-018-1009-2. Epub 2018 Jul 17. PMID: 30014280

Midha R. Epidemiology of brachial plexus injuries in a multitrauma population. Neurosurgery. 1997 Jun;40(6):1182-8; discussion 1188-9. doi: 10.1097/00006123-199706000-00014. PMID: 9179891

Domínguez-Páez M, Socolovsky M, Di Masi G, Arráez-Sánchez MÁ. Lesiones traumáticas aisladas del nervio axilar. Experiencia en 4 casos de transferencia nerviosa radial y revisión de la literatura [Isolated traumatic injuries of the axillary nerve. Radial nerve transfer in four cases and literatura review]. Neurocirugia (Astur). 2012 Nov;23(6):226-33. Spanish. doi: 10.1016/j.neucir.2012.06.003. Epub 2012 Jul 31. PMID: 22858051

Zalavras CG, Patzakis MJ, Holtom PG, et al. Management of open fractures. Infect Dis Clin North Am 2005;19:915–29

Dellinger EP, Caplan ES, Weaver LD, et al. The necessary duration of antibiotic administration after open fracture. Arch Surg 1988;123:333–9

Yang EC, Eisler J. Treatment of isolated type I open fractures: is emergent operative debridement necessary? Clin Orthop Rel Res 2003;410:289–94.

Skaggs DL, Friend L, Alman B, et al. The effect of surgical delay on acute infection following 554 open fractures in children. J Bone Joint Surg (Am) 2005;87:8–12

Barker W, Rodeheaver GT, Edgerton MT, et al. Damage to tissue defenses by a topical anesthetic agent. Ann Emerg Med 1982;11: 307–10.

Anglen JO. Comparison of soap and antibiotic solutions for irrigation of lower-limb open fracture wounds. A prospective, randomized study. J Bone Joint Surg Am 2005;87: 1415–22.

Fernandez R, Griffiths R, Ussia C. Water for wound cleansing. Cochrane Database Syst Rev 2002;(4).CD003861

Quah C, Whitehouse S, Agrawal Y, Shah N, Phaltankar P. Broken knife blade in proximal humerus: An unusual presentation. Eur J Orthop Surg Traumatol. 2009

Colin Cantrell a,*, Erik Gerlach a, Bennet Butler b, Ujash Sheth c, Vehniah Tjong a, The role of arthroscopy in bullet removal: A systematic review of the literature, Journal of Orthopaedics 22 (2020) 442–448, https://doi.org/10.1016/j.jor.2020.09.019

Mehmet Faruk Çatma1, Serhan Ünlü1, Önder Ersan1, Alper Öztürk1, Treatment of the Bullet, Traversing Femoral Neck, Lodged in Hip Joint: Initial Arthroscopic Removal and Subsequent Cartilage Repair, Journal of Orthopaedic Case Reports 2016 Sep‑Oct: 6(4):13‑16, doi: 10.13107/jocr.2250-0685.548

Leininger BE, Rasmussen TE, Smith DL. Experience with wound VAC and delayed primary closure of contaminated soft tissue injuries in Iraq. J Trauma 2006;61:1207–11

Mabee JR. Compartment syndrome: a complication of acute extremity trauma. J Emerg Med 1994;12:651– 6.

Downloads

Published

10-03-2022

How to Cite

1.
Impalement injuries of the shoulder: a case report with literature review . Acta Biomed [Internet]. 2022 Mar. 10 [cited 2024 Mar. 29];92(S3):e2021565. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/12563