Hydropneumothorax in an Isolated Midshaft Clavicle Fracture

Clavicle fractures are the fourth most common fracture. These fractures are either managed conservatively or surgically. Pneumothorax is a rare complication of clavicle fractures and potentially can be missed if this rare complication is not known.

A 76-year-old female presents with a 2-day history of pain and bruising over the right clavicular prominence following a fall from a standing height. Subsequent radiographs show the development of pneumothorax, despite having no respiratory symptoms.

Pneumothorax as a complication of isolated clavicle fractures is rare, with no case reports of hydropneumothorax in the literature. We hypothesize that the posterior displacement of the clavicle fragment penetrated the lung pleura resulting in the pneumothorax. We propose routine chest radiographs for patients presenting with clavicle fractures to rule out pneumothorax for the three reasons below. (1) Clinical features of pneumothorax might not be present upon patient's initial presentation, especially if they are relatively healthy individuals(2) Adequate pre-operative management if the patient is for surgical intervention (3) Assessment of surgical complications if the patient is for surgical intervention as iatrogenic pneumothorax is a potential complication of surgical fixation.

Thorough clinical examination and radiological evaluation should be performed with the diagnosis of pneumothorax in mind when a patient presents with a clavicle fracture to ensure early diagnosis and treatment of this life-threatening complication.