Integrated surgical management of forequarter lateral implosion injury: Technical considerations and early outcomes.
Shaun Kai Kiat Chua, Sunder Balasubramaniam, Peter A Cole et al.
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Case in brief
Two patients sustained high-energy road-traffic injuries with ipsilateral clavicle, scapula, and rib fractures, a pattern termed forequarter lateral implosion injury. CT with three-dimensional reconstructions and patient-specific printed models informed multidisciplinary incision planning and fixation sequencing. In each case, the fractures were stabilized during one operation in the lateral position using muscle-sparing approaches and staged fixation. Both patients had early pain resolution, functional shoulder motion, radiographic union, and return to work within months, without major complications.
What made this case unusual
The injury combines disruption of the shoulder girdle and chest wall; the authors describe coordinated fixation of the clavicle, scapula, and ribs in a single operative setting, an area with limited guidance.
Diagnostic / clinical pearl
Recognize ipsilateral clavicle, scapula, and rib fractures as a combined injury pattern: their cumulative biomechanical instability may warrant considering integrated stabilization rather than assessing each fracture in isolation.
Why it matters
The reported approach enabled immediate shoulder mobilization and intensive pulmonary rehabilitation, linking coordinated stabilization with early functional recovery in these two cases.