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Vacuum phenomenon in the shoulder of a child
  1. Partha Ray1,
  2. Ian CC King2 and
  3. Philip Stephen William Thomas3,4
  1. 1 Plastic Surgery, St. George’s University Hospital, London, UK
  2. 2 St. George’s University Hospital, London, UK
  3. 3 Orthopaedics, Queen Elizabeth Hospital, Gateshead, Tyne & Wear, UK
  4. 4 Orthopaedics, Sunderland Royal Hospital, Sunderland, Tyne & Wear, UK
  1. Correspondence to Partha Ray, partha.s.t.ray{at}


A 10-year-old boy struck a car bonnet following which his left shoulder got pinned under the wheel. No life-threatening injuries were identified. However, the patient sustained extensive abrasions to the back and the left shoulder, a closed deformity of the left clavicle and a swollen, but stable right knee. The patient was neurovascularly intact globally and all joints had a full range of motion. Plain radiographs suggested a possible greenstick fracture of the left clavicle, but also free gas within the left glenohumeral joint. Concern was raised of an unidentified open injury to the joint. CT was supportive of the finding of gas within the left glenohumeral joint, but ruled out the possible greenstick fracture as a spurious finding. There were no other injuries. The gas was within the left glenohumeral joint and was consistent with vacuum phenomenon. The injury was treated expectantly and the child made a full recovery.

  • radiology (diagnostics)
  • orthopaedics
  • paediatrics

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  • Contributors IK and PT treated the patient in the case and wrote the first draft of the manuscript in equal parts. IK obtained consent to write the manuscript from the patient’s mother and the patient. PR reviewed and revised the manuscript in it’s final form and compiled the figures supplementing the case report. All three authors have made a substantial contribution to drafting this paper and have read and approved this submission, which has been made as per the BMJ Case Reports instructions for authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Parental/guardian consent obtained.