Is Skin Tenting Secondary to Displaced Clavicle Fracture More Than a Theoretical Risk? A Report of 2 Adolescent Cases.

While one traditional indication for open reduction and internal fixation (ORIF) of clavicle fractures was tenting of the skin because of concern for an impending open fracture, recent review materials indicate that this complication may only be theoretical. To the best of the authors' knowledge, this complication has never been reported for a midshaft clavicle fracture. We report 2 adolescent cases of displaced, comminuted clavicle fractures in which the skin was initially intact. Both were managed nonoperatively and both secondarily presented with open lesions at the fracture site requiring urgent irrigation and débridement and ORIF. In displaced midshaft clavicle fractures, tenting of the skin sufficient to cause subsequent violation of the soft-tissue envelope is possible and is more than a theoretical risk. At-risk patients (ie, those with a vertically angulated sharp fragment of comminution) should be counseled appropriately and observed closely or considered for primary ORIF.