Arteriovenous Fistula Development After Nonoperative Treatment of a Clavicular Fracture: A Case Report

Medial clavicle shaft fractures in children and adolescents: differences from adults and management

Clavicle fractures are a common injury in the pediatric and adolescent population. Most fractures are located in the middle third of the clavicle. There has been no information in the literature regarding the management of extra-physeal medial clavicle shaft fractures in this population. The objective of this study is to evaluate demographic and injury characteristics, management options and clinical outcomes of medial clavicle fractures in children and adolescents and differentiate them from those in adults. A retrospective review was performed at a single institution to identify patients with medial clavicle shaft fractures. Radiographs, clinical features and patient-reported outcomes (QuickDASH) were analyzed. Eight patients were identified with medial clavicle fractures. Two fractures could not be diagnosed on anteroposterior radiographs. Both operative (four patients) and nonoperative (four patients) treatment had excellent radiographic and clinical outcomes, irrespective of initial displacement. Compared to high-energy and life-threatening injuries in adults, these fractures in children and adolescents were sports-related and isolated fractures. Conservative treatment should be considered for medial clavicle fractures in children and adolescents. These fractures are distinct from their adult counterparts and do not lead to increased morbidity or mortality.

Unusual Presentation of a Clavicle Fracture Locked Under the First Rib with Global Brachial Plexus Injury: A Case Report

CASE

Thoracic penetration of the medial half of clavicle fracture is rare and can be life-threatening and limb-threatening because of its proximity to the pleura and neurovascular structures. We report an unusual presentation of the medial portion of clavicle fracture locked under the first rib associated with the pneumothorax and global brachial plexus palsy successfully reduced by gentle manipulation. Partial injury to the subclavian vein was repaired. Nerve transfer was performed for brachial plexus palsy. The patient showed good functional recovery.

CONCLUSION

Reduction of locked intrathoracic clavicle fracture was performed safely by gentle manipulation. Subsequent appropriate interventions for the brachial plexus palsy led to a good outcome.

Contribution of Digital Subtraction Angiogram in Diagnosis and Anatomic Recognition of Traumatic Pulsatile Mass

Traumatic pulsating masses are difficult to make a definitive diagnosis due to anatomic variation of malformed vessels and rarely clinical incidence. It is essentially to recognizing the anatomy of such vessels, otherwise it may lead to an improperly treatment or serious complication. Digital subtraction angiogram (DSA) has a distinct advantage in both diagnosis and treatment of this subject. Here the authors report a case of venous malformation in the supraclavicular fossa with an underlying arteriovenous fistula following nonoperative management of a clavicle fracture in an adult, and discuss how to rule out potential differential diagnoses and get minimally invasive treatment with DSA.