Thoracic trauma (fractures, acromioclavicular joint injury, and pneumothorax)

Case contributed by Leonardo Lustosa

Presentation

Motorcycle accident. Intoxicated polytrauma patient (refers the use of alcohol). Painful right upper limb.

Patient Data

Age: 18 years
Gender: Female

Minimally displaced simple midshaft clavicle fracture, which can be classified as a Robinson type 2A1.

Minimally displaced scapular body fractures.

Widening of the acromioclavicular distance (9 mm) without elevation of the clavicle, suggesting a Rockwood type I acromioclavicular joint injury.

Displaced fractures of the 2nd, 3rd, and 4th left ribs.

Discrete left pneumothorax, marked by the absence of lung vessels on the pulmonary periphery incidentally noted.

Case Discussion

Fractures of the most superior ribs are associated with high-energy trauma, a motor vehicle accident in this case.

Rib fractures and scapular body fractures are usually also managed non-operatively.

Most clavicle fractures occur in the middle third and are treated conservatively.

Acromioclavicular joint injuries are usually the result of a direct hit to the shoulder which can rupture ligaments such as the coracoclavicular and acromioclavicular ligaments. The acromioclavicular distance is an important measurement in the evaluation of its respective ligament which may be injured when an acromioclavicular joint injury is suspected. The normal range of the AC distance is 1-3 mm. A widened distance indicates an acromioclavicular joint injury.

A small pneumothorax may be asymptomatic and be incidentally found, which happened in this case. The pneumothorax was later confirmed by a chest CT, which also found an associated pleural effusion, given the thoracic trauma, most likely a hemothorax.

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