PMC4275825_01
50-year old female with a 10-year history of diabetes mellitus with mid-third section fragmented bilateral clavicular fractures following a traffic accident within the vehicle. According to AO classification, right side fracture was 15-B2.3 and left-side was 15-B1.3.
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According to AO classification the clavicular fractures were type 15-B2.3 on the right side and type 15-B1.3 on the left side (Fig. 1).
(a) With a diagnosis of fragmented fracture in the mid third section of the right clavicle, open reduction under general anaesthesia and fixation with anatomic locking clavicular plate (TST, Kurtkoy, Istanbul) was applied to the patient on the 13th day post-trauma. (b) With a diagnosis of fragmented fracture in the mid third section of the left clavicle, open reduction under general anaesthesia and fixation with anatomic locking clavicular plate (TST, Kurtkoy, Istanbul) was applied to the patient on the 13th day post-trauma.
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With a diagnosis of fragmented fracture in the mid third section of both clavicles, open reduction under general anaesthesia and fixation with anatomic locking clavicular plate (TST, Kurtkoy, Istanbul) (Fig. 2a and b) was applied to the patient on the 13th day after post-trauma. 30 min preoperatively, 1 gr cefazolin iv was administered to the patient.
MRI image taken at postoperative 6 months showing abscess formation and appearance consistent with osteomyelitis in both clavicles.
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On the MRI taken of both shoulders, abscess formation and appearance compatible with osteomyelitis were seen (Fig. 3).
During debridement the mid-third of the left clavicle was seen to be sclerotic and infected, so a piece approximately 20 mm in size was excised as far as bleeding bone (paprika sign) from the left clavicle.
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As the mid-third of the left clavicle was seen to be sclerotic and infected, a piece approximately 20 mm in size was excised as far as bleeding bone (paprika sign) from the left clavicle and washed with plentiful saline (Fig. 4).
(a) AP clavicular radiograph 15 months post-trauma. (b) Image of the wound site 15 months post-trauma. (c) Shoulder movements 15 months post-trauma.
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The movements of both shoulders were normal and the DASH score was measured at 40 (Fig. 5a-c).