A 65-Year-Old Female with Missed Open Clavicle Fracture and Subsequent Fracture-Related Infection, Treated with Distal Clavicle Resection

Abstract

Introduction: Open clavicle fractures are rare, and there are no current reported cases in the literature of a missed open clavicle with resultant fracture-related infection and osteomyelitis.

Case report: We present a 65-year-old female with no reported medical history, who presented to our institution with left clavicular pain and wound drainage 8 days after she was struck by a motor vehicle in her home country of Guyana. She was found to have a missed open clavicle fracture with an associated severe infection. She was subsequently treated with irrigation, debridement, and distal clavicle excision.

Conclusion: We present this unique case with a potential procedure which could prove beneficial in cases of infection, trauma, or oncologic lesions in which the distal clavicle is deemed unsalvageable.

Keywords: Open clavicle fracture; bone infection; clavicular osteomyelitis; distal clavicle excision; missed open fracture; neglected fracture; osteomyelitis.

Figure 1

Clinical images of the posterior left shoulder demonstrating 5 cm × 2 cm ulceration and draining sinus with obvious purulence are shown.

Figure 2

Anteroposterior (a) and scapular Y (b) shoulder radiographs at initial presentation are shown demonstrating a Neer 2A distal clavicle fracture with significant superior displacement of the medial fragment.

Figure 3

Anteroposterior (a) and scapular Y (b) shoulder radiographs taken on post-operative day 1 are shown demonstrating the status post-lateral clavicle resection.

Figure 4

Clinical images taken during patient’s 4-week post-operative visit demonstrating a well-healed posterior left shoulder incision (a) and excellent range of motion (b, c, d) are shown.

Figure 5

Anteroposterior (a) and scapular Y (b) shoulder radiographs taken on 4 weeks postoperatively are shown demonstrating status post-lateral clavicle resection with maintained osseous alignment of the remaining medial clavicle without interval displacement.

Figure 6

Clinical images taken during patient’s 4-week post-operative visit demonstrating the patient’s ability to perform activities of daily living without issue are shown. Source: Kevin M Lehane, DO.