CASE REPORT

Midshaft clavicle fracture–—a trivial injury?

David A. Cairns*, David J. Ross

Department of Orthopaedic Surgery, Stirling Royal Infirmary, Livilands, Stirling, FK8 2AU, UK

Accepted 25 March 2004

Introduction

Midshaft clavicle fractures account for approxi-mately 70% of all adult clavicle fractures. Theycommonly occur as a result of a fall on to anoutstretched hand during sporting activity. Com-plications of these common injuries includemalunion, non-union and occasionally neurovascu-lar injury.4 Serious complications are extremelyrare.

We report the case of a patient presenting with apotentially life threatening complication of a mid-shaft clavicle fracture.

Case report

A 37-year-old right hand dominant man attendedour department after a fall from his mountain bike.He complained of pain only in the left shoulder and amidshaft clavicle fracture with minimal displace-ment was confirmed on the initial radiograph(Fig. 1). A collar and cuff were provided for immo-bilisation and a review appointment organised forthe next fracture clinic.

On return to the clinic 1 week later he com-plained of shortness of breath on exertion andwas noted to have a pronounced deformity of theclavicle. A chest radiograph confirmed an apicalpneumothorax with inferior displacement of thedistal fracture segment (Fig. 2). Review of the

original radiograph taken 1 week earlier showedno evidence of pneumothorax.

The patient was admitted to hospital for a shortperiod of observation and as his symptoms settledwas discharged home 1 day later without the needfor an intercostal drain. He was subsequentlyreviewed in the clinic for serial chest radiographswhich after 3 weeks showed complete resolution ofthe pneumothorax. 16 weeks post-injury heremained symptom free with a clinically and radi-ologically united fracture.

Discussion

Pneumothorax complicating a clavicle fracture haspreviously only been reported in the literature fourtimes.1—3,5 In each of these cases the Pneumothoraxwas apparent at initial presentation and requiredinsertion of an intercostal drain. Our patient wasinitially asymptomatic with no evidence of rib frac-ture, and we assume that the pneumothorax devel-oped secondary to inferior displacement of thedistal fracture segment into pleura.

Midshaft clavicle fractures must not be regardedas trivial injuries. The patient and all radiographsmust be thoroughly examined both initially and atearly outpatient follow up. A formal chest radiographshould always be requested if a pneumothorax issuspected, particularly when significant displace-ment of the fracture fragments has occurred.

Injury Extra (2004) 35, 61—63

*Corresponding author. Present address: 66 St. VincentCrescent, Flat 1/L, Glasgow G38NQ, UK. Tel.: þ44-141-5764671.

E-mail address: david.cairns7@ntlworld.com (D.A. Cairns).

1572–3461/$ — see front matter � 2004 Elsevier Ltd. All rights reserved.doi:10.1016/j.injury.2004.03.028

Figure 1 Clavicle fracture at presentation.

Figure 2 Clavicle fracture after 1 week with apical pneumothorax.

62 D.A. Cairns, D.J. Ross

References

1. Dugdale TW, Fulkerson TP. Pneumothorax complicating aclosed fracture of the clavicle: a case report. Clin Orthop1987;221:212—4.

2. Malcolm BW, Ameli FM, Simmons EH. Pneumothorax compli-cating a fracture of the clavicle. Can J Surg 1979;22(1):84.

3. Meeks RJ, Riebel GD. Isolated clavicle fracture withassociated pneumothorax: a case report. Am J Emerg Med1991;9(6):555—6.

4. Robinson CM. Fractures of the clavicle in the adult.Epidemiology and classification. J Bone Joint Surg Br 1998;80(3):476—84.

5. Williams RJ. Significant pneumothorax complicating a frac-tured clavicle. J Accid Emerg Med 1995;12(3):218—9.

Midshaft clavicle fracture–—a trivial injury? 63