Theodore G Phillips

Fracture of the Humeral Neck with Intrathoracic Dislocation of the Humeral Head

Intrathoracic fracture-dislocation of the humeral neck is a rare and easily overlooked clinical entity. We present a case and review of the literature. The objective of this study was to summarize the clinical presentation of this injury and to provide recommendations for initial diagnostic imaging and management. A 68-year-old man presented to the Emergency Department after a fall onto an abducted arm with moderate respiratory distress, mild left shoulder pain, and palpable crepitus over the shoulder and chest wall. Radiographic examination demonstrated the humeral head to be lying within the left hemithorax, devoid of any attachments to the remaining proximal humerus. After initial stabilization, the patient underwent surgical excision of the humeral head and delayed hemiarthroplasty. Careful attention to radiographic studies is required to recognize this injury. Initial management centers on airway management, adjunctive imaging, and treatment of any associated injuries followed by surgical excision and proximal humeral reconstruction.

Use of cardioplegia delivery equipment for rapid warm volume replacement after cardiopulmonary bypass

Often, after cardiopulmonary bypass involving aortic dissection, aortic root replacements, or valve conduits, rapid volume replacement with blood products is essential to obtain hemostasis and patient survival. We describe a method of using cardiopulmonary bypass equipment for rapid warm volume replacement and infusion of remaining residual volume in the cardiopulmonary bypass circuit after a cardiac operation.