Differential Diagnosis for Displaced Mid Clavicular Fracture with Inferior Displacement and Anteroinferior Dislocation of the Humeral Head
Single Most Likely Diagnosis
- Neer Type 3 Clavicle Fracture with Anterior Dislocation of the Shoulder: This diagnosis is the most likely due to the combination of a displaced mid-clavicular fracture with inferior displacement of the distal segment and an anteroinferior dislocation of the humeral head relative to the glenoid. The Neer classification is commonly used for clavicle fractures, and Type 3 specifically refers to a fracture that involves the distal third of the clavicle, which can be associated with other shoulder injuries like dislocations.
Other Likely Diagnoses
- Floating Shoulder Injury: This injury involves a fracture of the clavicle along with a fracture or dislocation of the scapula, particularly the glenoid or the coracoid process, which can lead to instability of the shoulder girdle. The presentation of a displaced clavicle fracture with associated shoulder dislocation could suggest a floating shoulder injury.
- Scapulothoracic Dissociation: Although less common, this severe injury involves disruption of the scapulothoracic articulation and can be associated with clavicle fractures and shoulder dislocations. The significant displacement and the involvement of the shoulder joint might suggest this diagnosis.
Do Not Miss Diagnoses
- Vascular Injury (Subclavian Artery or Vein): Given the proximity of the subclavian vessels to the clavicle, any significant displacement of a clavicle fracture, especially with associated dislocation, raises the concern for potential vascular injury. Missing such an injury could lead to severe complications, including bleeding, thrombosis, or embolism.
- Brachial Plexus Injury: The brachial plexus is also at risk with severe shoulder trauma, including clavicle fractures and shoulder dislocations. An injury to the brachial plexus could result in significant neurological deficits, making it a critical diagnosis not to miss.
Rare Diagnoses
- Panclavicular Fracture: This rare injury involves fractures at both ends of the clavicle, which could potentially present with significant displacement and instability of the shoulder girdle.
- Intrathoracic Dislocation of the Shoulder: Although extremely rare, this condition involves the humeral head dislocating into the thoracic cavity, which could be considered in the context of severe trauma with both clavicle fracture and shoulder dislocation.