Posterior dislocation of the clavicle causing fatal tracheoesophageal fistula

A 24-year-old man severely injured in a motor vehicle accident was found to have, on the right side, a pneumothorax, extrapleural hematoma, acromioclavicular dislocation and fracture of the first three ribs and of the transverse processes of C7 and T1. Through a right thoracotomy, transection of the right main stem bronchus and a laceration of the left main stem bronchus were discovered. These were repaired. Twenty days after admission, posterior dislocation of the clavicle at the sternum was noted. A diagnosis of tracheoesophageal fistula was made on the 32nd day but the symptoms had been sternoclavicular and acromioclavicular dislocations. At autopsy the medial end of the clavicle was found to be torn from its articular discand and locked behind the manubrium. The fistula was behind the posterior capsule between the carina and esophagus. The authors conclude that continued pressure from the displaced clavicle may have led to delayed necrosis of the esophagus and that reduction of the dislocated clavicle might have saved the patient's life.