26-year-old male with shotgun wound to the right shoulder presented with right distal open comminuted lateral third clavicle fracture with intact AC joint and large overlying skin defect. Fracture was grossly exposed with several free bony fragments. X-ray of right shoulder revealed multiple radiopaque foreign bodies surrounding the clavicle, superior chest and neck.
Initial I.V. antibiotics were administered for 72 hours, fracture site was washed out at bedside and visible metal debris was removed. Irrigation and excisional debridement of subcutaneous tissue, skin, muscle and bone was completed. Metal debris and pieces of the patient’s shirt were removed from wound. A thorough washout was completed with repeat debridement from superficial to deep layers to ensure all possible debris was removed. STIMULAN beads were used to fill the bone deficit at the fracture site. Antibiotic treatment was provided to prevent infection as the wound was contaminated. A layered closure of the fascia was carried out to cover the bone. A primary closure of the skin was completed with little tension and a wound VAC was placed over the incision.
Post-operative x-rays show partial absorption of STIMULAN beads at 1 month. Wound healing occurred 3 months after treatment, and at 6 months there was full consolidation of the clavicle fracture with complete absorption of STIMULAN beads. At 1 year, the patient remains infection free and without pain from remaining shotgun pellet debris.
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