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

Article information

J Musculoskelet Trauma. 2019;32(2):97-101

Publication date (electronic) : 2019 April 16

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

Hong-Ki Jin, M.D.

, Ki Bong Park, M.D.

, Hyung Lae Cho, M.D.

, Jung-Il Kang, M.D.

, Wan Seok Lee, M.D.

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, hongiroom@naver.com

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

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

Notes

^{Financial support}

None.

^{Conflict of interests}

None.

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The Korean Fracture Society

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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).

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.

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.