Medical Imaging Analysis Report

I. Radiological Findings

1. From multiple chest X-ray and CT images, a fracture line can be seen in the midshaft of the left (or right, depending on the actual condition) clavicle, with obvious displacement of the fracture ends. The proximal fragment may be pulled upward by muscles, while the distal fragment may shift downward.
2. On later images, pneumothorax and signs of infection (such as pleural effusion, purulent exudate, i.e., “pyo-pneumothorax”) are visible in the pleural cavity, along with local soft tissue swelling and inflammatory changes. In some images, an abnormal soft tissue density or air-fluid level within the thoracic cage suggests abscess formation.
3. Further follow-up images reveal poor callus formation at the fracture site, exhibiting signs of “clavicular nonunion,” with sclerosis at the fracture ends and no effective healing.
4. Regarding the surrounding tissues (lungs, pleural cavity, and mediastinum), in the early stage of the injury, compressive changes may be observed in the apex of the lung or lung fields. In the later stages, due to infection, diseased lung tissue may show increased density and decreased translucency.

II. Potential Diagnoses

1. Midshaft Clavicle Fracture with Pneumothorax/Pyothorax
   Since midshaft fractures are the most common type of clavicle fractures in adults, and due to muscular pull, the fracture fragments are prone to further displacement. In some cases, the sharp end may pierce the pleura, causing a delayed or acute pneumothorax, and subsequent infection can progress to pyo-pneumothorax and local abscess formation. The radiological findings are consistent with clinical manifestations.
2. Distal/Proximal Clavicle Fracture (Differential Diagnosis)
   Although the X-ray in this case indicates a fracture in the midshaft region of the clavicle, it is necessary to rule out fractures closer to the acromion or sternum. These fractures may be confused with shoulder or sternoclavicular joint lesions on imaging. Given the mechanism of injury (frontal collision), a midshaft clavicle fracture remains the most likely.
3. Other Chest Wall Injuries or Pulmonary Lesions (Differential Diagnosis)
   If the imaging shows abnormal density in the lung or chest wall soft tissues, accompanying rib fractures or pulmonary contusions should be considered. However, the most prominent pathology in this case remains the clavicle fracture with associated thoracic complications, which aligns with the clinical mechanism of injury.

III. Final Diagnosis

Based on the patient’s high-speed collision leading to a midshaft clavicle fracture, followed by further displacement of the fracture ends during postoperative or recovery phases—potentially piercing the pleura and causing delayed pneumothorax, pyo-pneumothorax, and abscess formation, and eventually resulting in nonunion—the most likely diagnosis is:

“Midshaft Clavicle Fracture with Multiple Thoracic Complications (Pneumothorax, Pyo-Pneumothorax, Chest Wall or Pulmonary Abscess Formation, Ultimately Leading to Clavicular Nonunion)”

IV. Treatment Plan and Rehabilitation Program

1. Acute Phase Treatment
   • For acute thoracic complications such as pneumothorax and pyo-pneumothorax, chest tube drainage or surgical intervention is required to ensure lung re-expansion and infection control.
   • Regarding the clavicle fracture, depending on the degree of displacement and associated complications, options include conservative treatment (e.g., sling or figure-of-eight bandage) or surgical fixation (plate fixation or intramedullary nailing). If there is significant instability or risk of pleural compromise, early surgical reduction and internal fixation should be considered.
   • During the infection phase, combination antibiotic therapy is essential to control pyo-pneumothorax or other bacterial infections. If localized abscesses are present, they may necessitate aspiration or surgical drainage.
2. Later Rehabilitation Guidance
   • Fracture Healing and Nonunion Management: If nonunion has occurred, surgical debridement of fibrous tissue and repeat internal fixation may be considered, along with bone grafting to promote healing.
   • Gradual Functional Exercises:
   1) Short Term (1-3 weeks post-surgery or after acute phase stabilization): Protective exercises using braces or bandages to avoid excessive movement. Encourage active movements of the fingers, wrist, and elbow to prevent joint stiffness.
   2) Mid Term (3-6 weeks): Once the fracture site is stable or adequately fixated, gradually increase passive and active range-of-motion (ROM) exercises for the shoulder joint, such as extension, abduction, and flexion. Avoid excessive external force.
   3) Long Term (after 6 weeks): If there is clear evidence of fracture healing, introduce resistance training, using resistance bands or light weights to restore shoulder and upper limb strength, prevent muscle atrophy, and improve shoulder function.
   • FITT-VP Principle:
   • Frequency: Start with 3-4 sessions per week and increase to 5 when tolerated.
   • Intensity: Begin with low-intensity exercises, such as light resistance bands or bodyweight activities, and progress gradually based on pain and swelling.
   • Time: 20-30 minutes per session initially, gradually extending to 40 minutes.
   • Type: Range-of-motion exercises, resistance band activities, aerobic exercises (e.g., walking or stationary cycling).
   • Progression: Increase the resistance, difficulty, or duration as fracture healing and functional recovery progress.
   • Volume: Incorporate rest days and follow a gradual approach, avoiding excessive loading.
   • During training, closely monitor local pain, swelling, and joint mobility. If severe pain or other abnormalities occur, seek prompt medical consultation or adjust the regimen.
3. Considerations for Cardiopulmonary Function and Other Special Conditions
   If the patient’s respiratory function is compromised due to thoracic complications, lung function exercises (e.g., pursed-lip breathing, diaphragmatic breathing) should be added to the rehabilitation program to gradually improve cardiopulmonary endurance.

Disclaimer: This report provides a reference-based analysis grounded on the supplied clinical and imaging data. It does not replace an in-person consultation or professional physician’s diagnosis and treatment plan. Follow your specialist’s guidance for specific diagnosis and management.