Abstract
Among adults, post-traumatic osteomyelitis following a closed fracture is a rarely described entity in the literature, with the involvement of the clavicle bone being particularly uncommon. Early diagnosis and treatment of clavicular osteomyelitis is crucial to prevent serious consequences such as sepsis, mediastinitis and haemorrhage from the great vessels. A 54-year-old male patient presented to the emergency department complaining of fatigue and limited mobility after having fallen and hit his head and right shoulder 10 days previously. No major injury was found during the diagnostic procedure, and the patient was discharged. 2 weeks later, the patient returned with clinical signs of right upper arm cellulitis and probable sepsis. Diagnostic ultrasound imaging and MRI of the right upper arm, as well as re-examination of the X-ray image, confirmed acute complex osteomyelitis of the right clavicle following an overlooked clavicle fracture. Microbiological analysis confirmed clavicular osteomyelitis caused by Escherichia coli septicaemia. Despite prompt treatment with i.v. antibiotics and surgery, the patient's condition rapidly deteriorated and he passed away. Our case demonstrates the critical importance of early diagnosis and appropriate treatment of a closed fracture. Late diagnosis may lead to severe complications, such as complicated osteomyelitis and sepsis, and even a fatal outcome. Furthermore, a brief literature review is presented of previously reported acute osteomyelitis following a closed fracture, including evidence of affected bone and isolated pathogens. Although uncommon, osteomyelitis should be considered a possible cause of a deteriorating clinical condition in patients with a history of recent trauma.
Highlights
Osteomyelitis of the clavicle is an uncommon form of infection caused by haematogenous or contiguous spread, or trauma.[1,2,3]
The case presented demonstrates the critical importance of early diagnosis of acute osteomyelitis and the appropriate treatment of a closed fracture, as well as the importance of preventive treatment of skin and soft tissue wounds, which present a potential risk for local and systemic bacterial infection
Early diagnosis of acute osteomyelitis and appropriate treatment of closed fractures are vital for a successful treatment outcome
Summary
Osteomyelitis of the clavicle is an uncommon form of infection caused by haematogenous or contiguous spread, or trauma.[1,2,3] This rare condition is difficult to diagnose. 2 weeks later, the patient returned to the emergency department complaining of fatigue, diffuse arthralgia and myalgia, with severe pain in his right shoulder. The skin on his right upper arm was swollen, reddened and painful to palpation, and his right axillary lymph nodes were enlarged. An emergency ultrasound examination of the upper arm showed a collection of thick fluid with the presence of gas bubbles and a free fragment of the cortical bone (Figure 1) At this point, the shoulder X-ray image that was taken during the patient’s first visit to the hospital was re-examined, and a clavicle fracture in the distal third of the clavicle was diagnosed (Figure 2). The patient’s condition deteriorated rapidly, and he passed away the following day
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
