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Delayed presentation of Subclavian venous thrombosis following undisplaced clavicle fracture

DOI: 10.1186/1749-7922-3-25

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Abstract:

Injuries to the clavicle are very common and account for up to 10% of all fractures[2]. Midshaft and lateral third clavicle fractures are common sporting injuries; the vast majority present without neurovascular injury and proceed to uncomplicated union [1-3]. Fractures to the medial clavicle are uncommon, accounting for only 2–5% of all clavicle fractures [2-5] and are often due to high energy injuries. The medial clavicle protects the brachial plexus, subclavian and axillary vessels and the superior lung. Fractures can therefore be complicated by damage to these structures.Much of the literature and research has concentrated on midshaft and distal clavicle fractures and acromioclavicular joint injuries. We aim to highlight the difference in mechanism of injury and complications associated with medial third clavicle fractures.In general, vascular injuries following clavicle fractures are uncommon but are recognised as either an immediate complication due to transection of the vessel by the displaced fracture [6,7], or as a late complication, secondary to compression from abundant callus formation. There have been several reported cases of venous insufficiency associated with clavicle fractures [8-11] and of acute compression of the subclavian vessels following displaced midshaft fractures[12]. There have also been reported cases of neural injury associated with these common injuries [13].Isolated injuries of the medial end of the clavicle are uncommon and are usually part of multisystem injuries[14]. Throckmorton and Kuhn presented a review of all clavicle fractures treated at their institution over a five year period. Out of 614 clavicle fractures, only 57 were identified as medial third fractures. 80% of these occurred in middle aged men. Just over 80% of these injuries were associated with motor vehicle accidents (53% were passengers/driver of a vehicle; 16% were pedestrians hit by a vehicle; 11% motorcycle accidents). Ninety percent of cases were defined as hav

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