Fracture-dislocation of clavicle

Case contributed by Yusra Sheikh
Diagnosis certain

Presentation

Direct impact over the medial left clavicle during sports.

Patient Data

Age: 14 years
x-ray

There is a subtle lucency traversing the medial clavicle, but not extending to the cortex, suggestive of a fracture. Sternoclavicular joint alignment appears congruent. 

A subtle non-displaced fracture involving the medial left clavicle is confirmed on CT. In addition, there is a posterior dislocation of the left sternoclavicular joint. A focus of ossific density is seen in the soft tissue, most suggestive of myositis ossificans. No mediastinal hematoma on soft tissue windows (not shown) and no pneumothorax.

Case Discussion

The patient went on to have a CT of his clavicle 2 weeks later, as the referring clinician was concerned regarding the congruency of the left sternoclavicular joint. No intervention was performed on this child and there wasn't any further follow up.

Ideally, a contrast-enhanced CT examination should be performed in cases of suspicious posterior dislocation of sternoclavicular joint, to evaluate the mediastinal vessels.

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