Presentation
Right shoulder pain post a motorbike accident at 60 km/h.
Patient Data
Initial radiograph shows a transverse fracture through the right scapular neck. There is an associated subtle lucency through the right distal clavicle underlying the external ECG lead, suspicious for a distal clavicle fracture.
Follow up radiograph 2 weeks later again shows a transverse fracture through the right scapular neck which is now 50% displaced. The removal of the external ECG lead on the follow up radiograph reveals a right distal clavicle fracture with 30% displacement.
Case Discussion
In this case both the emergency department and initial report author missed the right distal clavicle fracture on the first radiograph, which was masked by the external ECG lead. Follow up x-ray 2 weeks later (external ECG lead removed) reveals an associated distal clavicle fracture. This case highlights the importance of adequately exposing the patient as much as possible along with correlation of clinical and radiographic findings.
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