Clavicle Fracture with Subclavian Vessel Disruption and Hemothorax
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Clavicle Fracture and Subclavian Vessels Disruption with Massive Haemothorax Mimic Intrathoracic Injury
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Original source:
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Wan Ismail Faisham, Paiman Mohammad, Haron Juhara, Nik Mahdi Munirah, Hassan Shamsulkamaruljan, Ghazali Mohamad Ziyadi
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Clavicle Fracture and Subclavian Vessels Disruption with Massive Haemothorax Mimic Intrathoracic Injury
Year: 2011
Copyright (license): CC BY 4.0
Download the PDF file of the original publication
Summary of article contents:
Introduction
Clavicle fractures are common injuries, accounting for approximately 5% of all fractures. However, associated neurovascular damage is rare and is often linked to penetrating injuries rather than fractures sustained from blunt trauma. This report presents a unique case of a 19-year-old male who suffered an open clavicle fracture due to a motorbike collision, resulting in severe injury to the subclavian artery and vein, as well as perforation of the pleura, leading to massive hemothorax. The rare nature of this case highlights the need for awareness in diagnosing and managing such injuries.
Massive Hemothorax and Subclavian Vascular Injury
In this case, the patient arrived at the hospital with substantial bleeding from a chest wound, left upper limb dusky coloration, and absent pulses. Emergency imaging revealed extensive left-sided pneumohemothorax and a displaced clavicle fracture. Initial treatments included tube thoracostomy that yielded significant blood drainage and angiographic assessment of vascular injury. During surgical exploration via thoracotomy, a large volume of blood was found, along with a laceration in the subclavian vein and spasm of the subclavian artery. Following vascular repair with a reverse saphenous graft, the perforated pleura was also repaired, and stabilization of the fractured clavicle was achieved.
Conclusion
While clavicle fractures are generally considered benign, this case underscores the potential for significant complications, such as intrathoracic vascular injuries and massive hemothorax. Urgent intervention, such as thoracotomy and vascular repair, is essential to manage these critical injuries effectively. The report emphasizes the importance of careful evaluation and prompt treatment of suspected vascular injuries associated with clavicle fractures to prevent potentially life-threatening outcomes.
FAQ section (important questions/answers):
What led to the patient's open fracture of the clavicle?
The patient was involved in a high-speed head-on collision with a lorry while riding a motorbike, resulting in multiple injuries including the clavicle fracture with associated vascular damage.
What complications arose from the clavicle fracture?
The open clavicle fracture caused laceration of the subclavian artery and vein, along with perforation of the pleura, leading to a massive haemothorax that required emergency thoracotomy.
How was the massive haemothorax managed in the patient?
Emergency thoracotomy was performed to explore the chest, where collected blood and clots were removed. The subclavian vessels were repaired, and pleural perforation was addressed.
What was the outcome for the patient following treatment?
The patient was discharged after 12 days in the hospital with full strength and sensation in the left upper limb, indicating successful recovery post-surgery.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Clavicle Fracture with Subclavian Vessel Disruption and Hemothorax”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Bleeding:
Bleeding refers to the loss of blood from the vascular system, which can occur due to injury such as fractures or vessel damage. In this case, continuous bleeding from a chest wound indicated significant trauma, necessitating urgent medical intervention to prevent hypovolemic shock and organ failure.
2) Blood:
Blood is the vital fluid that circulates through the body, delivering oxygen and nutrients to tissues and removing waste products. In the described case, the presence of blood in the thoracic cavity highlighted the severity of the vascular and pleural injuries, requiring immediate surgical exploration.
3) Dressing:
Dressing refers to materials applied to injuries to protect wounds, control bleeding, and promote healing. In this case, a compressive dressing was used on the chest wound to temporarily manage external bleeding while preparing for possible surgical intervention and to stabilize the patient’s condition.
4) Pulse:
Pulse is the rhythmic expansion and contraction of arteries as blood is pumped by the heart. The absence of radial and ulnar pulses in the patient suggested vascular compromise, indicating significant injury to the subclavian artery and necessitating urgent thoracic exploration.
5) Knowledge:
Knowledge in a medical context refers to the understanding and awareness of medical conditions, treatment protocols, and potential complications. The authors demonstrated knowledge of the rare association between clavicle fractures and vascular injuries, informing their clinical decisions in managing this complex case.
6) Grafting:
Grafting refers to the surgical technique of using tissue (e.g., a blood vessel) from one part of the body to repair or replace damaged structures. In this case, reverse saphenous vein grafting was employed to reconstruct the injured subclavian vessels, restoring blood flow to the upper limb.
7) Surface:
Surface in the medical context often refers to the outer layer of organs or tissues. In this case, the surface of the pleura was perforated, allowing blood to enter the thoracic cavity, contributing to massive hemothorax and necessitating surgical repair to address the injury.
8) Filling (Filled):
Filling within a medical context may refer to the restoration or presence of substances such as blood within a vessel or space. In this case, filling defects observed in angiography indicated compromised vascular flow in the subclavian artery, which was a critical finding for surgical planning.
9) Repair:
Repair involves surgical procedures aimed at mending damaged tissues or organs. The repair of the lacerated subclavian artery and vein, as well as the pleural perforation, were crucial steps taken during thoracotomy to address the life-threatening injuries sustained by the patient.
10) Field:
Field in a clinical setting usually refers to the area of practice or study. In this case, the field of trauma surgery was relevant, as the medical team had to address multiple complications stemming from a traumatic clavicle fracture, highlighting their expertise in managing such injuries.
11) Study (Studying):
Study in this context refers to the research and analysis conducted to understand medical cases and improve treatment outcomes. The case report contributes to the broader study of trauma-associated vascular injuries, potentially guiding future clinical practices for similar cases.
12) Post:
Post refers to the period or conditions following a medical event or intervention. In this case, post-operative evaluations and follow-ups were crucial for assessing the recovery of the patient and ensuring proper healing of the clavicle fracture and vascular repairs.