Disclosures: Abhinav Mohan, MD: No financial relationships or conflicts of interest

Case Description: Our patient was admitted to rehabilitation on post-op-day 8 following open repair of a traumatic right mid-shaft humerus fracture with stainless-steel plate fixation. She was cleared by the surgeon for weight-bearing-as-tolerated of the right-upper-extremity (RUE). DVT prophylaxis was not initiated until rehab admission. On examination, she exhibited distal RUE edema. She denied pain and had no new falls/trauma since the surgery. She was found to have hypoalbuminemia. ACE-bandage treatment was started, and the next day the swelling had migrated to above the elbow, with 14cm bicep circumference. She had normal elbow range-of-motion. Further ACE-bandage/manual treatments were unsuccessful, as was bumetanide. Ultrasounds showed no thrombus or soft tissue collection. Per cardiology, amlodipine was not responsible. On post-op-day 15, patient heard an insensate “pop” and the right bicep circumference increased to 17cm. On examination, the right arm was hinged mid-shaft. X-ray revealed mid-shaft fracture of the humerus, including fracture of the plate, prompting repeat repair and steel plate fixation. She was discharge back to rehab, this time as non-weight-bearing (NWB) to the RUE.

Setting: Inpatient Rehabilitation Facility (IRF)

Patient: 70 year old obese female with history of hypertension (on amlodipine), heart failure, and atrial fibrillation who suffered a motor vehicle accident with multiple traumatic injuries, including a right mid-shaft humerus fracture. Assessment/

Results: Under NWB precautions, the patient successfully completed the inpatient rehabilitation program and was discharged home at a modified independence level with left quad cane.

Discussion: Due to lack of pain, no range-of-motion limitation, absence of attributable new trauma, and recent fixation with steel plate, a repeat fracture was not initially suspected. Furthermore, she had multiple comorbidities pointing to other causes on the differential, leading to the delay in diagnosis.

Conclusion: New post-operative swelling may represent a repeat fracture, even in cases with steel plate fixation. Postoperative weight-bearing precautions should be liberalized with caution.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/whats-that-swelling-a-case-of-mistaken-identity/