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Abstract: A 47-year-old sister fell down in a collision with another person on an electric bicycle and landed on the upper lateral side of her left shoulder. Subsequently, she developed severe pain and significant swelling in the lateral part of the left shoulder clavicle and limited abduction of the left shoulder joint, and this accidental traffic accident caused a fracture of the acromion end of the patient’s left clavicle. This accident caused a fracture of the acromion of the left clavicle. If the fracture does not heal, it may affect the abduction function of the shoulder joint, so after consultation, the patient underwent internal fixation with fracture dissection, and with the combined effect of medication and rehabilitation, the patient’s shoulder joint function recovered well.
Basic information】Female, 47 years old
Disease Type】Fracture of the left clavicle and acromion
Hospital】Liaocheng Second People’s Hospital
Consultation time】04/2022
Treatment plan】Medication (hepaticoside sodium tablets to reduce swelling + flurbiprofen injection + cefazolin sodium for injection) + surgery (fracture incision and internal fixation) + rehabilitation (active practice of flexion and extension of the left elbow joint and fingers of the left hand + passive practice of small abduction of the left shoulder joint)
Treatment period】15 days of inpatient treatment, 1 and 4 months of outpatient follow-up
Results】Fracture healing and functional recovery of the left shoulder joint
I. Initial consultation
She entered the orthopedic emergency room with the help of her family members, and was told that the patient had just collided with another person on an electric bicycle and had fallen off the car. The patient was found to have local skin abrasions and obvious swelling on the left shoulder, and the lateral part of the clavicle was deformed, and he felt severe pain when he touched the lateral end of the clavicle with his hand, and he could feel abnormal activity with local pressure.
We explained the X-ray results to the patient and his family and informed them that the fracture of the acromion of the clavicle was obviously misaligned and extremely unstable, and that conservative treatment would have a high risk of non-union and might affect the abduction function of the shoulder joint in the future, so surgery was recommended. If conservative treatment was chosen, the left acromion should be fixed with local pressure and the right upper extremity should be suspended by a triangular scarf for 6-8 weeks, and the patient should come to the hospital to take pictures for review at 1, 4, 8, 16 and 1 month after the injury. The surgical treatment required internal fixation of the fracture with an incision and repositioning of the clavicle hook and titanium plate under anesthesia, which is a reliable method of repositioning and fixation and allows the patient to perform functional exercises of the shoulder joint at an early stage. The family thought that the patient was young and might need to engage in a certain degree of heavy physical activity in the future, which required a high degree of shoulder function, and wanted to perform functional exercises of the left shoulder joint early, so they agreed to the surgical treatment and admitted him to the hospital.
II. Treatment history
After admission, he was given local ice packs on the left shoulder, and applied symptomatic treatment such as hepaticoside sodium tablets to reduce swelling and flurbiprofen ester injection to relieve pain. On the second day after admission, laboratory tests such as routine blood tests, coagulation six items and preoperative four items were completed, and the patient was actively prepared for surgery. On the third day after admission, the patient underwent internal fixation of the fracture under brachial plexus anesthesia. The patient was instructed to practice the flexion and extension activities of the left elbow joint and fingers of the left hand actively after 48 hours, and the patient’s family members were instructed to help the patient practice the small-amplitude abduction activities of the left shoulder joint passively 7 days after surgery.
III. Treatment effect
The patient’s incision healed well 12 days after surgery, and the stitches were removed successfully. After surgical treatment, the fracture of the acromion of the clavicle was well repositioned and fixed, and the patient was discharged at 15 days of hospitalization. One month after discharge, the patient’s left shoulder skin abrasion healed, the swelling of the shoulder joint subsided, the flexion and extension of the fingers of the left hand and the left elbow joint returned to normal, and the passive abduction of the left shoulder joint was basically restored; the patient was instructed to gradually practice active abduction and forward extension of the left shoulder joint. When the patient came to the hospital for review 4 months after discharge, the fracture was basically healed, and the left shoulder joint abduction, forward extension, dorsal extension and activities were basically restored to the pre-injury level, and the patient could do dressing, eating and hair combing by himself. At this time, the patient was asked to gradually start to engage in heavy physical activities.
IV. Precautions
We are glad that the patient’s symptoms have improved after treatment, but we suggest that the patient should continue to brake the affected limb with the upper limb suspension for 1 month after discharge, so during this period the patient can actively practice the flexion and extension activities of the affected fingers, wrist and elbow joint, and passively practice the abduction and forward flexion activities of the affected shoulder joint, and avoid unprotected weight-bearing activities of the affected upper limb, such as riding a bicycle, driving a car, and engaging in heavy physical activities. If the fracture heals smoothly and the internal fixation is reliable, you can remove the upper limb suspension belt and gradually practice the abduction, flexion and extension of the shoulder joint on the affected side, and rotate the front and back activities.
V. Personal insight
By understanding the situation of the patient in this case, we know that when there is severe local pain, swelling and limitation of joint movement after direct violent trauma to the shoulder, we need to consider the possibility of shoulder fracture, including the fracture of the acromion of the clavicle, and suggest that the patient should actively seek medical attention to clarify the injury in order to obtain standardized treatment measures. Conservative treatment is suitable for patients with less pronounced dislocation, stable fracture ends, and good compliance with local compression external fixation with a triangular scarf, especially in elderly patients who do not have high functional requirements of the shoulder joint. The fracture of the acromion of the clavicle has a high incidence of dislocation and non-union, which should be taken into account when choosing a treatment plan. While surgical treatment can restore the normal structure and stability of the acromioclavicular joint, gradual postoperative functional exercise of the affected limb under the guidance of a physician is equally important to achieve good treatment results.