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Abstract
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Introduction
Fractures of the medial third of the clavicle are rare (only 2-4% of clavicle fractures).
This type of fractures is due to high-energy trauma associated with multiple organic injuries and a high mortality rate.
In case of posterior dislocation of the clavicle, serious complications can occur: compression/injury of vascular and nerve structures, trachea, esophagus, and pneumothorax.
In young patients, epiphysiolysis is more common than fracture.
The physis in fact does not close until the age of 20-25 years.
In case of posterior dislocation or relevant instability, the treatment of the lesion can be surgical.
We present here a case report of a rare case of simultaneous epiphysiolysis and medial fracture of the clavicle, treated surgically.
Methods
A 17-year-old patient fell from his bicycle onto his right shoulder, complaining of pain not only in the shoulder but also in the sternal area.
He had no skin lesion, dysphagia, dyspnea, or sensory-motor deficits, and vital signs were normal.
Imaging (standard RX and angio-CT) demonstrated a posteriorly displaced medial clavicle fracture with a dislocation of the sternal clavicle joint, with compression of residual thymic tissue.
We proposed open reduction and internal fixation of the fracture to the patient.
Under general anesthesia was inducted in dorsal decubitus.
A transverse incision centered on the fracture was made.
After the fragment was released and anatomic reduction was achieved, a grind locking plate (1.0 mm) was attached.
Intraoperative imaging after fixation, the clavicle remained elevated with respect to the contralateral, due to epiphysiolisis found after further exploration of the intact periosteum.
We reduced the epiphysiolysis by reducing the clavicula in its periosteal sleeve and fixed with transosseous sutures. The periosteum was closed to cover the plate.
Results
The clavicles are symmetrical, and the patient has resumed a complete and symmetrical mobilization without pain.
The Oxford Shoulder Score at 5 months post-operative was 12/60. The radiological result was satisfactory without signs of displacement.
Conclusions
Medial clavicle fracture-dislocations are rare but potentially serious injuries.
Posterior dislocation always requires surgical intervention.
In our particular case, surgical treatment allowed us to diagnose epiphysiolysis.
Even in case of a confirmed fracture, the suspicion of a lesion of the physis plate must be considered, to avoid malunion.
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