Spontaneous Clavicle Fracture in Beta Thalassemia Major

Case Report

Ann Hematol Oncol. 2019; 6(4): 1241.

Spontaneous Clavicle Fracture in Beta Thalassemia Major

Merchant RH¹, Doctor PN², Choudhari AK³ and Pandey AR4*

1Department of Pediatrics, Nanavati Super Speciality Hospital, Mumbai, India

2Resident, Children’s Hospital of Michigan, US

3Department of Radiology, Nanavati Super Speciality Hospital, Mumbai, India

4Nanavati Super Speciality Hospital, Mumbai, India

*Corresponding author: Pandey AR, M.B.B.S. Intern, Nanavati Super Speciality Hospital, SV Road, Vile-Parle (West), Mumbai-56, Maharashtra, India

Received: January 25, 2019; Accepted: February 27, 2019;Published: March 06, 2019


We present a 20 years old beta thalassemia major patient with sudden onset swelling over left clavicular region, which turned out to be a spontaneous clavicular fracture. Osteopathy in Thalassemia major is prominent cause of morbidity.

Keywords: Thalassemia major; Osteopathy; Fracture clavicle

Case Report

A 20-year-old male with beta-thalassemia major presented with a sudden spontaneous swelling over the left clavicle with no history suggestive of trauma. Four years ago, he had developed idiopathic focal segmental glomerulosclerosis, which progressed to chronic renal failure. Three months earlier he had a hypocalcaemic seizure with serum total calci-um of 5.3 mg/dl and serum 25-hydroxy Vitamin D of 5 mg/ml. Dual-energy X-ray absorptiometry done revealed osteo-porosis with a T score of 2.8. Physical examination showed restriction of movement of left arm and shoulder due to pain, the swelling measured 5 × 4 × 2 cm (Figure 1), was firm in consistency, with tenderness over the left clavicle, it was not fluctuant or pulsatile and did not transilluminate. A diagnosis of hematoma was suspected. Chest X-ray was normal, however, Zanca view of the clavicle detected a minimally displaced fracture between the proximal and middle third of the left clavicle along with osteoporosis of the humerus (Figure 2). Magnetic resonance imaging showed a minimally displaced fracture of the left clavicle with a hematoma arising from the fracture site extending into upper fibres of pectoralis major with no injury to neurovascular bundles (Figure 3a&b). The patient was managed conservatively with pain control, ice application and figure of eight bandages, besides receiving oral 25-hydroxy Vitamin D3 and oral alendronate to improve bone mineral density and prevent recurrence of fracture. He has subsequently recovered completely.