062-b THE FLOATING SHOULDER TRAUMA

The trauma took place on October 2nd as the result of a fall (while on his race bicycle) on the right shoulder.

Following the trauma I visited the emergency department of a hospital in Udon Thani. There I consulted an orthopaedic surgeon.

My body language was apparently clear enough for him to diagnose this, without any physical examination or questioning as a ‘dislocation of the shoulder’. After this he sent me, as mentioned, without any examination, to the Röntgen department for 1 (one) X-ray of the right shoulder.

After having seen the X-ray he had to revise his initial diagnosis. It was NOT a dislocation of the shoulder, but a fracture of the right scapula. The right shoulder was not dislocated or fractured. After asking him about the status of my clavicula , he answered that the clavicula was OK. Also after this X-ray, there was no physical examination, and I did not even have to (partly) undress in order for him to assess the injury better.

In summary: a fracture of the right scapula without dislocation or other abnormalities

Therapy

Sling to support the arm. Start practising the shoulder and arm as soon as possible. Adequate calcium and oral analgesia if necessary. Follow-up consult in a few weeks time.

Comments on this first consult

  • There was no physical examination of the patient.
  • The attention of the orthopaedic surgeon was fixed on only the shoulder.
  • Insufficient X-ray examination of the lesion (A more extensive X-ray examination, especially of the clavicle, should have been done).
  • In case an adequate physical examination would have taken place, as a normal consequence a better X-ray examination of the clavicula should have been performed.
  • Afterwards: a clavicula fracture is visible on the single X-ray made, which was missed by both the radiologist and the orthopaedic surgeon.
    (The clavicula was poorly portrayed on this X-ray).

My thesis

In case of a scapula fracture, the clavicula must be examined extensively, in order to prevent that a FLOATING SHOULDER diagnosis is missed. The X-ray made in my case was clearly insufficient.

After the trauma

In the weeks following the trauma, the injury became more and more problematic. There was increasing pain and I was unable to actively elevate my arm. For these reasons I went, after about two weeks, back to the hospital for a new examination.


This second consultation by the same specialist yielded nothing. Notwithstanding that:

  1. I told him that I had more pain.
  2. I told him that I did not only have pain in the shoulder but also in my chest.
  3. I told him that I was not able to actively lift my arm.
  4. I got my upper body bared to show him the large haematoma and swelling of the medial clavicula.

The specialist said:

  1. There was nothing special going on.
  2. An X-ray of the clavicula was not necessary.
  3. He would make a new X-ray in three weeks time.
  4. A follow-up consult should then also take place.

As my feelings told me that more was broken then only the scapula, I felt very disappointed and this led to my decision to go for a second opinion. I did this on October 25 at another hospital in Udon Thani.

Second opinion

After extensive physical and X-ray (4 photos) examination, it was not difficult to come to the diagnosis: Floating shoulder, with severe dislocation of the clavicular fracture and 4 (four) rib fractures.

I got surgery of the dislocated clavicula fracture by osteosynthesis. After the surgery I felt much better and only from that moment on the recovery could start.

Conclusions

  1. The misdiagnosis and the unprofessional treatment delayed the start of the healing process with 3 (three) weeks.
  2. The misdiagnosis and the unprofessional treatment and delayed start of the healing process will cause the healing process to last longer.
  3. The misdiagnosis and the unprofessional treatment resulted in 3 weeks of unnecessary pain.
  4. The total lack of attention to any possible additional injuries exposed me to unnecessary health risks.

I hope that the treating orthopaedic specialist  will read my story.