![]() ![]() Neurologic and vascular examinations of his extremities were normal. On further examination, he did appear to have crepitus over his right clavicle and gross deformity in his right thigh. His primary survey revealed diminished breath sounds over his right hemithorax in conjunction with an increased respiratory rate. ![]() He was emergently brought to the trauma center in stable condition. Emergency medical personnel at the scene did report the deployment of the airbags with the patient displaying a Glasgow Coma Scale score of 15. The patient was unrestrained and did not lose consciousness in the accident. The displacement of the lateral segment prompted the insertion of a chest thoracostomy tube.Ī 22-year-old intoxicated male without any medical comorbidity was involved in a motor vehicle accident when he lost control of his automobile in a residential area and ultimately collided into a house. We report a case of a closed proximal third clavicle fracture causing a pneumothorax from intrapleural penetration of the lateral fracture fragment treated with an open reduction and internal fixation to achieve both union of the fracture as well as resolve the pneumothorax. Others have published their results with closed management of the clavicle fracture and a chest tube for the pneumothorax. ![]() Both the clavicle fracture and pneumothorax were managed conservatively. reported a case of an isolated clavicle fracture complicated by a pneumothorax in a person involved in a bicycle accident. The method of treatment for the clavicle fracture was either a sling or a figure-of-eight swathe. None of these reports describe intrapleural invasion of the fracture fragment, and therefore, a chest thoracostomy tube was sufficient in the management of the lung collapse for significant pneumothoraces. There have been few reports in the literature of clavicle fractures complicated by pneumothoraces, but to the best of our knowledge, only one has been managed operatively. Among the various complications associated with clavicle fractures, pneumothorax has not been widely reported. Most of these series have been in individuals with clavicular nonunions and delayed unions. Despite the high union rates of closed treatment, there have been recent reports of success with operative management of closed clavicle fractures. While open reduction and internal fixation of open clavicle fractures is generally accepted, this is not true of closed injuries. Operative management of these injuries has been traditionally reserved for specific clinical scenarios including vascular or neurologic compromise, ipsilateral shoulder trauma, and open fracture. Until recently, most clinicians have agreed to treat closed fractures nonoperatively with a sling or a figure-of-eight shoulder immobilizer for 4-6 weeks. Various reports have established that clavicle fractures account for nearly 5% of musculoskeletal trauma and approximately 35% of shoulder fractures. Follow-up radiographs showed a healed clavicle fracture and resolved pneumothorax.įractures of the clavicle are common injuries treated by orthopedic surgeons. 2 days after stabilization of his right femur fracture, the patient underwent open reduction with internal fixation of his right clavicle. Given the severe displacement of his clavicle fracture into the lung tissue resulting in pneumothorax, there was significant concern for nonunion and lack of resolution of the pneumothorax. The patient was initially placed in a sling and underwent intramedullary nailing of his femur on the day of presentation. Computerized tomography studies later revealed that the fractured clavicle had penetrated the pleura and caused the partial lung collapse. A chest thoracostomy tube was inserted and placed under suction. Neurovascular examinations of his extremities were normal. Radiographic studies of his chest demonstrated a right proximal third clavicle fracture with inferior displacement with associated partial pneumothorax the patient was also noted to have a right femoral shaft fracture. On the primary survey, the patient was noted to be tachypneic with decreased breath sounds over his right hemithorax. A 22-year-old intoxicated male with no past medical history was admitted to the trauma bay in stable condition after being involved in a motor vehicle accident. ![]()
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