Pseudoaneurysm of the subclavian artery as a delayed complication of a clavicle fracture.

Vascular complications are relatively rare following surgical fixation of midshaft clavicle fractures. Here, we report a case of a woman in her 30s presenting 10 years after right clavicular open reduction and internal fixation with revision 6 years prior with sudden and rapidly progressive neck swelling. Physical examination revealed a soft pulsating mass in her right supraclavicular fossa. Ultrasound and CT angiography of the head and neck showed a pseudoaneurysm of her right subclavian artery with a surrounding haematoma. She was admitted to the vascular surgery team for endovascular repair with stenting. Postoperatively, she developed arterial thrombi requiring thrombectomy (twice) and is now on lifelong anticoagulation. It is crucial to be aware of complications that can develop in patients with a history of clavicular fracture managed non-operatively or operatively even years later and highlights the importance of risk and benefit discussions and counselling.

Non-operative Management of an Accidental Knee Intra-articular Nail.

Nail gun injuries are relatively common presentations to the emergency department. The majority of these injuries occur to the hands and rarely result in long-term morbidity. However, despite the large number of cases each year, little research is available regarding the optimum emergency management of nails that implant intra-articularly. Initial studies suggested that cases of nails penetrating intra-articular or neurovascular structures warranted operative debridement; however, newer studies have suggested cautious nail removal, wound debridement, irrigation, antibiotic coverage, and tetanus prophylaxis are equivalent to operative intervention for the management of most intra-articular nails. We present a gentleman in his 40s with accidental penetration of a nail fired from a nail gun into his right knee. He was neurovascularly intact. After initial evaluation and management, he was transported to a higher level of care for operative management. However, the nail was ultimately removed bedside utilizing adequate anesthesia.