Progressive Brachial Plexus Palsy after Fixation of Clavicle Shaft Nonunion: A Case Report

Hong Ki Jin; Ki Bong Park; Hyung Lae Cho; Jung Il Kang; Wan Seok Lee

doi:10.12671/jkfs.2019.32.2.97

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Case Report Progressive Brachial Plexus Palsy after Fixation of Clavicle Shaft Nonunion: A Case Report: Hong Ki Jin, Ki Bong Park, Hyung Lae Cho, Jung Il Kang, Wan Seok Lee; Journal of Musculoskeletal Trauma 2019;32(2):97-101.
DOI: https://doi.org/10.12671/jkfs.2019.32.2.97
Published online: April 30, 2019

Department of Orthopedic Surgery, Good Samsun Hospital, Busan, Korea. hongiroom@naver.com

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Abstract

The brachial plexus palsy is a rare complication of a clavicle fracture, occurring in 0.5% to 9.0% of cases. This condition is caused by excessive callus formation, which can be recovered by a spur resection and surgical fixation. In contrast, only seven cases have been reported after surgical reduction and fixation. A case of progressive brachial plexus palsy was observed after fixation of the displaced nonunion of a clavicle fracture. The symptom were improved after removing the implant.

Keywords: Clavicle fracture, Nonunion, Brachial plexus neuropathy, Thoracic outlet syndrome

J Korean Fract Soc. 2019 Apr;32(2):97-101. Korean.
Published online Apr 16, 2019.
https://doi.org/10.12671/jkfs.2019.32.2.97

Case Report

Progressive Brachial Plexus Palsy after Fixation of Clavicle Shaft Nonunion: A Case Report

Hong-Ki Jin

, M.D., Ki Bong Park

, M.D., Hyung Lae Cho

, M.D., Jung-Il Kang

, M.D. and Wan Seok Lee

, M.D.

Author information

Author notes

- Department of Orthopedic Surgery, Good Samsun Hospital, Busan, Korea.
Correspondence to: Hong-Ki Jin, M.D. Department of Orthopedic Surgery, Good Samsun Hospital, 326 Gaya-daero, Sasang-gu, Busan 47007, Korea. Tel: +82-51-310-9289, Fax: +82-51-310-9348, Email: hongiroom@naver.com

Received November 21, 2018; Revised January 02, 2019; Accepted January 17, 2019.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Keywords

Clavicle fracture, Nonunion, Brachial plexus neuropathy, Thoracic outlet syndrome

Figures

Fig. 1
Distance from the 1st rib to the clavicle of the non-union side changed from 41.2 mm (A, preoperative) to 28.5 mm (B, postoperative). After implant removal (C) displacement recurred and the distance increased to 42.1 mm. Three-dimensional computed tomography shows that bony spur alone coraco-clavicular ligament (A) was completely removed (B, C). The level of the scapular spine migrated 24.6 mm upward after fixation (B) and returned to the preoperative state after implant removal (C).

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Fig. 2
(A) Postoperative thoracic outlet magnetic resonance imaging (MRI) shows normal brachial plexus continuity witout hematoma. (B) Cervical spine MRI shows cervical disc degeneration without both disc herniation or spinal cord lesion.

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Fig. 3
(A) Normal contour of the clavicle was recovered after a strut bone graft and fixation. (B) A 16 mm step off of the medial clavicle fragment occurred immediately after removing the plate.

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Notes

Financial support:None.

Conflict of interests:None.

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Dongju Shin, Jae Hwi Han
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Progressive Brachial Plexus Palsy after Fixation of Clavicle Shaft Nonunion: A Case Report

J Korean Fract Soc. 2019;32(2):97-101. Published online April 30, 2019

DOI: https://doi.org/10.12671/jkfs.2019.32.2.97