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The Vacuum Phenomenon in the Elbow: A Case Report
Tyler J Smith1, Anthony Judice1, Salvador Forte1
1Department of Orthopedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
JBJS Case Connector
|September 10, 2020
Summary
The vacuum phenomenon (VP), or intra-articular gas in closed injuries, is reported in a distal humerus fracture. This rare finding in elbow fractures highlights the need for physician awareness to prevent misdiagnosis and patient harm.
Area of Science:
- Orthopedic Surgery
- Radiology
- Trauma Care
Background:
- Distal humerus fractures are common orthopedic injuries.
- The vacuum phenomenon (VP) is characterized by intra-articular gas, typically seen in axial skeleton injuries.
- Awareness of VP in appendicular fractures is limited.
Observation:
- A 33-year-old male sustained a closed distal humerus fracture from a fall.
- Computed tomography revealed intra-articular gas, indicative of VP.
- No signs of arthrotomy, open fracture, or soft tissue defects were present.
Findings:
- This case represents the first reported instance of VP in a closed distal humerus fracture.
- The presence of intra-articular gas in this context challenges previous understandings of VP distribution.
- The vacuum phenomenon is an under-recognized finding in appendicular skeletal injuries.
Implications:
- Increased physician awareness of VP in elbow fractures is crucial.
- VP should be considered in the differential diagnosis of closed fractures, even in the appendicular skeleton.
- Recognizing VP can prevent unnecessary interventions and improve patient management.
