Fletcher C, Fletcher KL. A delayed and recurrent pneumothorax complicating a fractured clavicle - A novel presentation.
Trauma Case Rep 2020;
26:100294. [PMID:
32140535 PMCID:
PMC7044753 DOI:
10.1016/j.tcr.2020.100294]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2020] [Indexed: 12/05/2022] Open
Abstract
There are very few reports in the literature about clavicular fractures being associated with a pneumothorax. With this combination of injuries, there are also minimal reports of a delayed presentation of a pneumothorax. This is the first report of a delayed pneumothorax followed by a recurrence of a pneumothorax due to the fractured ends of the clavicle. This case report describes a 49-year-old man who sustained a right-sided pneumothorax from a fractured clavicle several hours after a bus accident. His initial chest examination and radiographs showed no evidence of a pneumothorax. The pneumothorax resolved after 5 days of treatment with a thoracostomy tube. After removing the tube, the procedure was repeated later that day as he again developed a pneumothorax. Ten days later, the patient had surgical intervention of the clavicle due to the unresolved pneumothorax. The clavicle is usually managed conservatively in patients sustaining a clavicular fracture and pneumothorax, however, surgical intervention was mandatory based on failed conservative management. At 3 months follow up, the patient had normal shoulder function. Clinicians must be aware that fractured ends of the clavicle may cause repeated pulmonary damage resulting in a delayed and or a recurrent presentation of a pneumothorax.
This is the first reported case of a delayed pneumothorax and a recurrent pneumothorax following an ipsilateral clavicular fracture
chest X-ray is done in the presence of a clavicle fracture to ensure a potentially fatal pneumothorax is not present
ongoing monitoring of the respiratory system in patients who sustained a clavicle fracture especially with a high energy mechanism of injury is mandatory
the clavicle is usually successfully conservatively managed, operative management is mandatory in cases whereby the pneumothorax is not resolving despite appropriate thoracostomy tube placement
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