Forequarter Lateral Implosion Injury: A Review of Recognition and Multidisciplinary Management
Vladislav Muldiiarov, David J. Weatherby, Thomas W. White, Mark Ayzenberg, Zachary M. BaumanABSTRACT
Background
Forequarter lateral implosion injury (LII) is a severe combined injury of the chest wall and ipsilateral shoulder girdle after high‐energy trauma. This review summarizes current evidence and provides a practical framework for recognition, multidisciplinary assessment, and management.
Methods
Published literature on combined ipsilateral chest wall and shoulder‐girdle injuries was reviewed and synthesized by a clinical topic. This evidence was integrated with the authors' clinical perspectives on recognition, multidisciplinary assessment, treatment selection, and operative planning.
Results
LII is characterized by combined disruption of the chest wall and shoulder girdle, often including displaced or segmental rib fractures with clavicular and/or scapular injury. Computed tomography (CT) is central to identifying chest wall instability, shoulder‐girdle displacement, and global forequarter malalignment. Available evidence supports multidisciplinary assessment but does not justify routine fixation of every injured component. Operative management should be selective and based on established chest wall and orthopedic indications, respiratory physiology, injury severity, functional demands, and surgical expertise.
Conclusions
LII should be recognized and assessed as an integrated chest wall‐shoulder girdle injury rather than a collection of isolated fractures. Combined or staged reconstruction may be appropriate when operative indications coexist, whereas nonoperative management remains appropriate in selected patients. Further studies are needed to define treatment selection and long‐term functional outcomes.