Fractura de clavícula de Midshaft. ¿Lesión trivial? (Inglés)

David A. Cairns, and David J. Ross

<img src="http://www.sciencedirect.com/cache/MiamiImageURL/B7CRN-4CHRH0H-3-4/0?wchp=dGLbVtz-"

Figure 2. Clavicle fracture after 1 week with apical pneumothorax.

The patient was admitted to hospital for a short period of observation and as his symptoms settled was discharged home 1 day later without the need for an intercostal drain. He was subsequently reviewed in the clinic for serial chest radiographs which after 3 weeks showed complete resolution of the pneumothorax. 16 weeks post-injury he remained symptom free with a clinically and radiologically united fracture.

Discussion
Pneumothorax complicating a clavicle fracture has previously only been reported in the literature four times.[1., 2., 3. and 5.] In each of these cases the Pneumothorax was apparent at initial presentation and required insertion of an intercostal drain. Our patient was initially asymptomatic with no evidence of rib fracture, and we assume that the pneumothorax developed secondary to inferior displacement of the distal fracture segment into pleura. Midshaft clavicle fractures must not be regarded as trivial injuries. The patient and all radiographs must be thoroughly examined both initially and at early outpatient follow up. A formal chest radiograph should always be requested if a pneumothorax is suspected, particularly when significant displacement of the fracture fragments has occurred.

Injury Extra. Volume 35. 7-8. July-August 2004, Pages 61-63