The Pucker Sign: A Rare Finding Associated With Humeral Neck Fracture
Journal Title: Emergency Medicine – Open Journal - Year 2016, Vol 1, Issue 4
Abstract
A 43 year old Caucasian female presented to the Emergency Department with a left shoulder injury after falling from a “mini-barstool” which she was standing on to reach an overhead shelf. The mechanism was unclear as the patient did not remember what happened. She did remember the fracture occurring and the onset of severe pain with inability to move her arm immediately after the fall. Her past history was remarkable for mental health issues and illicit drug use including crack cocaine and marijuana. Physical examination was remarkable for the patient holding the involved extremity in an adducted, internally rotated position by supporting it with the contralateral upper extremity. Additionally, puckering of the skin along with ecchymoses was noted over the proximal anterior upper extremity (Figures 1 and 2). Radiographs of the injury demonstrated a comminuted fracture of the surgical neck of the left humerus. (Figure 3) Orthopedic evaluation of the patient was accomplished in the emergency department. Because the skin dimpling resolved with gentle traction in the emergency department, the patient was placed in a cuff and collar and discharged with instructions to do no weight bearing of the left upper extremity and to follow-up with orthopedics in one week. Over the next several weeks several emergency department visits occurred for uncontrolled pain and medication refill requests. There were also several follow-up evaluations at the orthopedic clinic. Open Reduction and Internal Fixation (ORIF) was subsequently planned but was canceled on the day of surgery because the patient’s urine drug screen was positive for cocaine.
Authors and Affiliations
Larry B. Mellick
Keywords
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- EP ID EP546631
- DOI 10.17140/EMOJ-1-118
- Views 126
- Downloads 0
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