Massive Subcutaneous Emphysema with Bilateral Pneumothorax and Pneumoscrotum Following Clavicle Fracture without Rib Fracture: A Rare Case Report.

Introduction: Clavicle fractures are common injuries encountered in orthopedic practice, but the combination of bilateral pneumothorax, extensive subcutaneous emphysema, and pneumoscrotum without rib fractures is rare and potentially fatal. These complications are usually accompanied by pneumomediastinum and air leak in cases of blunt chest trauma. Case Report: A 74-year-old male fell and sustained a fracture of the right clavicle and scapula. While in hospital, he presented with respiratory symptoms and widespread chest wall, neck, back, and scrotal subcutaneous emphysema. Thoracic computed tomography revealed bilateral pneumothorax, extensive subcutaneous emphysema, and no rib fractures. He was intubated, and a drain was placed in an intercostal space. The fractured clavicle was treated with open reduction and internal fixation with a plate and screws. After the removal of the intercostal drain (ICD), the patient had recurrent subcutaneous emphysema with respiratory distress that required re-intubation and re-insertion of the ICD. The patient recovered with further conservative management and was discharged well. Conclusion: Pneumoscrotum with extensive subcutaneous emphysema after clavicle fracture without rib fracture is rare. Potential air leak and pneumomediastinum should be thought of, and close monitoring with late removal of the ICD is required to avoid recurrence.