Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture

 

What to Learn from this Article?

Unique scenario of progressive brachial plexus palsy following osteosynthesis of clavicle


Case Report |  Volume 3 | Issue 3 | JOCR July-Sep 2013 | Page 18-21 | Rosati M, Andreani L, Poggetti A, Zampa V, Parchi P, Lisanti M.


Authors: Rosati M[1], Andreani L[1], Poggetti A[1], Zampa V[2], Parchi P[1], Lisanti M[1]

[1]Orthopaedic and Traumatology I Department, University of Pisa.

[2]Diagnostic I Department, University of Pisa.

Address of Correspondence:

Dr Marco Rosati: Orthopaedic and Traumatology I Department, University of Pisa 050/996504 050/996501 (fax). Email: rosati1961@gmail.com.


Abstract

Introduction: The thoracic outlet syndrome (TOS) is a rare complication of clavicular fracture, occurring in 0.5-9% of cases . In the  literature from 1965 – 2010,  425 cases of TOS complicating a claviclular fracture were described.  However, only 5 were observed ​​after a surgical procedure of reduction and fixation. The causes of this complication were due to the presence of an exuberant callus, to technical surgery errors or to vascular lesions. In this paper we describe a case of brachial plexus plasy after osteosynthesis of clavicle fracture.

Case Report: A 48 year old female, presented to us with inveterate middle third clavicle fracture of 2 months duration. She was an alcoholic, smoker  with an history of opiate abuse and was HCV positive. At two month the fracture was displaced with no signs of union and open rigid fixation with plate was done. The immediate postoperative patient had signs of neurologic injury. Five days after surgery showed paralysis of the ulnar nerve, at 10 days paralysis of the median nerve, radial and ulnar paresthesias in the territory of the C5-C6-C7-C8 roots. She was treated with rest, steroids and neurotrophic drugs. One month after surgery the patient had signs of complete denervation around the brachial plexus. Implant removal was done and in a month ulnar and median nerve functions recovered. At three months post implant removal the neurological picture returned to  normal.

Conclusion: We can say that TOS can be seen as arising secondary to an “iatrogenic compartment syndrome” justified by the particular anatomy of the space cost joint. The appropriateness of the intervention for removal of fixation devices is demonstrated by the fact that the patient has returned to her daily activities in the absence of symptoms and good functional recovery in about three months, despite fracture nonunion.

Keywords: Brachial plexus palsy, clavicle fractures, outlet thoracic syndrome.


 

How to Cite This Article: Rosati M, Andreani L, Poggetti A, Zampa V, Parchi P, Lisanti M. Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture. Journal of Orthopaedic Case Reports 2013 July-Sep ;3(3): 18-21. Available from: http://www.jocr.co.in/wp/2013/07/10/2250-0685-109-fulltext/


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