Case report: Delayed subclavian vein injury secondary to clavicular malunion. 2012

Derek R Cooney, and Brian Kloss
Department of Emergency Medicine, State University of New York Upstate Medical University, 550 East Genesee Street, Syracuse, NY 13202, USA.

BACKGROUND Fractures of the clavicle are extremely common, representing 2.6-12% of all fractures and 35-44% of all shoulder girdle injuries; 69-82% of these fractures occur in the middle third of the clavicle. Vascular injuries relating to clavicle fracture are usually due to extreme force applied to the clavicle in an acute setting. No other reports of delayed subclavian vein laceration were found on literature search. OBJECTIVE We present this case to increase awareness among emergency physicians of the potential delayed presentation of this rare condition. METHODS A 21-year-old man presented to the Emergency Department with acute swelling of the base of the neck after carrying a heavy load on his left shoulder the night before. He had been recovering from a clavicle fracture for 2 months. Malunion of his left midshaft clavicle fracture led to subclavian vein injury and formation of a large hematoma secondary to reinjury that occurred at work the night before presentation. Computed tomography revealed a 9-cm hematoma at the fracture site. The patient was found to have a subclavian vein injury without evidence of arterial injury or nervous system involvement. The patient was admitted for observation and subsequently discharged without need for surgical intervention. CONCLUSIONS Subclavian vein laceration is a rare complication of clavicle fracture. Patient education at discharge after conservative management is important due to the risk of vascular complications from malunion and reinjury.

UI MeSH Term Description Entries
D008297 Male Males
D009333 Neck The part of a human or animal body connecting the HEAD to the rest of the body. Necks
D002968 Clavicle A bone on the ventral side of the shoulder girdle, which in humans is commonly called the collar bone. Collar Bone,Bone, Collar,Bones, Collar,Clavicles,Collar Bones
D006406 Hematoma A collection of blood outside the BLOOD VESSELS. Hematoma can be localized in an organ, space, or tissue. Hematomas
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D013350 Subclavian Vein The continuation of the axillary vein which follows the subclavian artery and then joins the internal jugular vein to form the brachiocephalic vein. Subclavian Veins,Vein, Subclavian,Veins, Subclavian
D017759 Fractures, Malunited Union of the fragments of a fractured bone in a faulty or abnormal position. If two bones parallel to one another unite by osseous tissue, the result is a crossunion. (From Manual of Orthopaedic Terminology, 4th ed) Fracture Malunion,Fractures, Abnormal Union,Fractures, Crossunited,Malunion, Fracture,Crossunited Fracture,Crossunited Fractures,Fracture Malunions,Fracture, Abnormal Union,Fracture, Crossunited,Fracture, Malunited,Malunions, Fracture,Malunited Fracture,Malunited Fractures
D055815 Young Adult A person between 19 and 24 years of age. Adult, Young,Adults, Young,Young Adults

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