(Disclaimer: This article is for scientific use only, and relevant information in the following content has been processed to protect patient privacy)
Abstract: Clavicle fractures are mostly due to indirect violence, and local swelling, ecchymosis and pain occur after the fracture. In this case, a 58-year-old woman suffered a clavicle fracture because she landed on her shoulder after a slip and fall, which was not treated after the fracture, and she still had pain and swelling in the clavicle fracture area with limited shoulder joint movement before admission. After surgical treatment, the fracture healed successfully and the shoulder joint regained its normal mobility.
Basic information】Female, 58 years old
Disease Type】Clavicle fracture
Hospital】The First Hospital of Harbin Medical University
Date of consultation】April 2022
Treatment plan】Surgical treatment (fracture incision and internal fixation) + triangular scarf suspension brake
Treatment period】10 days of inpatient treatment, 1 year of regular review after surgery
Effectiveness】Significantly increased range of motion compared with that before surgery
I. Initial consultation
The patient, 58 years old, was a farmer who fell during a field work and suffered swelling and pain in the clavicle area. The patient did not pay attention to the fracture because the displacement was not obvious, and continued to work after the injury. However, the pain became worse and worse, and the shoulder joint became impaired, so he came to the clinic. On examination, it was found that the patient had obvious swelling in the clavicular region with pressure pain, mild muscle atrophy of the left upper limb, and limited movement of the left shoulder joint. x-ray showed that the fracture line of the left clavicle existed and the fracture end was partially displaced. The patient was diagnosed with a clavicle fracture with delayed fracture healing.
II. Treatment history
The patient was overwhelmed by the painful fracture and decided to be hospitalized for surgical treatment. After admission, the upper limb was given a suspension brake using a triangular scarf to reduce the upper limb’s pull on the fracture end, and the patient’s pain was temporarily relieved. The patient’s pain was temporarily relieved. Subsequently, an X-ray of the shoulder joint was completed to clarify the cause of the difficulty in moving the shoulder joint. Routine preoperative tests such as routine blood and liver and kidney functions were completed and showed no abnormalities. The fracture was then resected and internally fixed under general anesthesia on the 3rd day after admission. The surgery focused on removing the hyperplastic scar and bone scab from the fracture end, fixing the fracture end with an internal fixation plate, and then performing a manual release of the shoulder joint. After the surgery, a triangular scarf suspension was continued.
III. Treatment results
The patient’s fracture deformity disappeared on the second day after surgery, and the pain at the original fracture end was relieved, but he felt swelling in the surgical area and pain in the incision. On the 4th day after surgery, the swelling in the surgical area was relieved, the incision was not significantly painful, and the left shoulder could be actively lifted, but still had soreness and pain. At the time of discharge, the upper limb was suspended by a triangular scarf, and the affected limb could move actively with the assistance of the healthy limb, and the range of motion was significantly increased compared with that before surgery, with mild soreness and pain. On the 10th day of hospitalization, the patient’s incision was free of infection and abnormal exudation and healed smoothly, so the patient was discharged.
IV. Notes
We are glad that the patient’s fracture healed successfully. Because of the delayed healing of the clavicle fracture, the patient had chronic pain in the clavicle area, which affected the shoulder joint movement. After surgery, the affected limb can continue to be suspended by a tricot during the day. The affected limb should be lifted up at night while sleeping, and attention should be paid to shoulder flexion and extension rotation activities during the day. If there is no discomfort, the internal clavicle fixation can be kept in the body for a long time.
V. Personal insight
Most clavicle fractures are caused by indirect violence. If the fracture displacement is not serious, conservative treatment is feasible. In this patient, although the fracture displacement is not obvious, the fracture was not braked after the fracture, which led to the persistence of micro-movement of the fracture end, and the fracture has not healed for 3 months after the fracture. Surgery is the best option in this case, as it not only repositions and fixes the fracture, but also removes the hyperplastic scar and scab present at the fracture end, which facilitates fracture healing.