Shoulder disarticulation after clavicle fracture: a case report

In this case report, we presented to a 90-year-old female with multiple comorbidities presented to the emergency department of our hospital three weeks following a fall from standing height. Upon arrival, the patient exhibited a Glasgow Coma Scale (GCS) 12, blood pressure of 100/60 mmHg, heart rate of 117 beats/min, respiratory rate of 24 breaths/min. Examination revealed atrophy, skin color change, sensory disturbance, or motor palsy in the left upper extremity. Chest X-ray showed a fractured left clavicle, with its free fragment dislocated toward the thorax. She was diagnosed with a displaced midshaft clavicle fracture, Arbeitsgemeinschaft für Osteosynthesefragen (AO) type 15.2B2. On doppler ultrasound examination, flow loss secondary to compression was observed in the proximal left subclavian artery (SA). No flow was observed in the axillary, brachial, radial and ulnar arteries. Due to the patient's high number of comorbid diseases and poor general condition, disarticulation was performed from the shoulder joint, which is the proximal region of arterial occlusion. No other symptoms of circulatory dysfunction were observed at the 3 months follow-up. This case report emphasizes that delayed clavicle fracture can lead to catastrophic consequences. Trauma surgeons should also consider surgical treatment of clavicle fractures, depending on the patient's condition.