title: Clavicle fracture with thoracic penetration and hemopneumothorax but without neurovascular compromise.
abstract: Clavicle fractures are rarely associated with more severe neurologic or vascular injuries. When these associated injuries are encountered, prompt recognition and treatment are paramount to optimize outcome. The majority of fractures that result in neurovascular compromise are from high-energy trauma; however, a high index of suspicion should be present in all cases as low-energy trauma can also result in more catastrophic injury. This article describes a case of a low-energy clavicle fracture in a 28-year-old woman that resulted in intrathoracic penetration of the fracture fragment with hemopneumothorax. The patient underwent successful chest tube placement and open reduction and internal fixation of the fracture. A multidisciplinary team was used during surgery, including cardiothoracic, trauma, and orthopedic surgery. Two years postoperatively, the patient was back to normal activities with no neurologic, pulmonary, or vascular sequelae. This case highlights the importance of a comprehensive physical examination and inspection of all radiographs so that associated injuries are not missed.
authors.affiliation: Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. fotios.tjoumakaris@rothmaninstitute.com
authors.forename: Fotios P
authors.initials: FP
authors.lastname: Tjoumakaris
authors.forename: Jonas L
authors.initials: JL
authors.lastname: Matzon
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Williams
mesh_terms: D000328:Adult; D002968:Clavicle / Q000293:injuries* / Q000601:surgery; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000601:surgery; D006468:Hemopneumothorax / Q000209:etiology* / Q000601:surgery; D006801:Humans; D010348:Patient Care Team; D013902:Radiography, Thoracic; D013898:Thoracic Injuries / Q000150:complications* / Q000601:surgery; D013909:Thorax / Q000098:blood supply / Q000294:innervation; D020196:Trauma, Nervous System; D016896:Treatment Outcome; D057772:Vascular System Injuries; D014950:Wounds, Penetrating / Q000150:complications* / Q000601:surgery