A Case Report of Trauma-induced Coagulopathy in the Setting of an Isolated Humeral Shaft Fracture

Introduction: Humeral shaft fractures are common orthopedic injuries often resulting from high-energy trauma in young patients and low-energy trauma in the elderly. Non-operative management has traditionally been the mainstay of treatment for isolated and low-energy humeral shaft fractures, with operative management reserved for severe cases often involving neurovascular compromise. This case describes a rare, yet catastrophic complication of a humeral shaft fracture where the patient developed trauma-induced coagulopathy (TIC), resulting in amputation of the affected extremity, systemic inflammatory response syndrome (SIRS), and ultimately death.

Case report: A 60-year-old female patient with an isolated left humeral shaft fracture was originally treated with closed reduction and splinting. The patient returned 6 days later with a dysvascular left upper extremity and subsequently decompensated over the next 2 weeks secondary to TIC and SIRS. This resulted in a left transhumeral amputation, dysvascular right upper extremity, multiorgan failure, and ultimately death.

Conclusion: This report serves as a unique clinical example of rapid decompensation related to TIC and SIRS in the setting of a humeral shaft fracture. Managing orthopedic teams must be aware of these rare sequelae of humeral shaft fracture and be prepared to respond rapidly with surgical intervention and consultation of additional services to limit associated morbidity and mortality.