Radiographs of the clavicle revealed a fracture of the medial aspect of the clavicle and the possibility that there was extension of the fracture into the sternoclavicular joint with possible dislocation (Fig. 1). Therefore a CT scan was performed.
The CT scan confirmed a comminuted fracture of the medial end of the clavicle with relative superior displacement of the lateral part of the clavicle (Fig. 2a). The sternoclavicular joint was intact (Fig. 2b). There was soft tissue swelling around the medial part of the left clavicle but there was no evidence of mediastinal or intra-thoracic injury (Fig. 2c).
Intra-articular fractures may be overlooked unless computed tomography is used. They can result in secondary osteoarthritis with persistent pain.
Fractures of the middle third, with or without sternoclavicular dislocation, can lead to vascular injury and this should raise clinical suspicion and lead to a low threshold for radiological investigation. Vascular laceration is an early complication of fracture of the clavicle and it can result in a relatively high morbidity and even mortality.
Diagnosis of Bone and Joint Disorders, 3rd Edition.
WB Saunders Company, Philadelphia (1995).
Klier I, Maor P.
Laceration of the innominate internal jugular venous junction.