Case report-Vascular injury in association with posteriorly displaced medial clavicle fracture

Abstract

The primary stabiliser of the diarthrodial sterno-clavicular (SC) joint is the costo-clavicular ligament, this holds the clavicle to the first costal cartilage and the end of the first rib. The costo-clavicular and surrounding ligaments help maintain the stability and strength of the SC joint. As a result, SC joint dislocations are far less common than fractures to the clavicle due to the relatively larger forces required to disrupt these ligaments. Medial physeal injuries occur when there is a fracture through the physis of a clavicle which is yet to complete the ossification process, this can often be mistaken for sterno-clavicular joint dislocation. This report looks at a case of a posteriorly displaced medial physeal fracture in an adolescent male sustained while playing rugby. We hope this case provides the reader an insight into the potentially life threatening consequences that should be considered in such presentations and highlight the importance of prompt and appropriate imaging and specialist intervention.

Keywords: Dislocation; Fracture; Physeal; Posterior; Subclavian; Vascular.

Fig. 1

Initial CT scan of right physeal fracture/posterior dislocation – mass effect on upper mediastinum including vasculature and trachea.

Fig. 2

CT arteriogram demonstrating injury to proximal right subclavian artery.

Fig. 3

4 month right clavicle follow up radiograph.