The challenging management of a delayed union midshaft clavicle fracture complicated by an acute pseudoaneurysm of the subclavian artery in a superelderly diabetic patient

Clavicle fractures are among the most common fractures, accounting for 2.6–4% of all adult fractures and for 35–44% of those of the shoulder girdle. Up to 80% occur at the midshaft. Nowadays, the majority of these fractures tend to be treated non-operatively, even when displaced, using an arm supporting sling or a “figure-of-eight” bandage, with good clinical outcomes and an acceptable rate of nonunion. On the contrary, operative treatment is commonly performed in cases of open fractures, skin tenting with the potential for progression to open fracture, “floating shoulder,” and associated acute neurovascular injuries. Despite the proximity of the clavicle to the subclavian vessels, vascular complications in closed clavicle fractures are uncommon, with an incidence of 0.4% [2]. Nevertheless, their prompt diagnosis and proper knowledge is essential because of the high morbidity and mortality rates associated. This report describes the clinical, diagnostic, and therapeutic approaches to address an acute subclavian artery pseudoaneurysm caused by a closed displaced clavicle fracture, complicated by delayed union, in a comorbid octogenarian patient.