Clin Orthop Surg.  2009 Mar;1(1):54-57. 10.4055/cios.2009.1.1.54.

Surgical Treatment of Thoracic Outlet Syndrome Secondary to Clavicular Malunion

• Yoo MJ
• Seo JB
• Kim JP
• Lee JH

• KMID: 1127915
• DOI: http://doi.org/10.4055/cios.2009.1.1.54

Abstract

According to the literature, thoracic outlet syndrome (TOS) secondary to the malunion of displaced fractures of the clavicle is rare. Various surgical methods, including simple neurolysis, resection of the first rib or clavicle and corrective osteotomy, have been reported. We report a case of TOS secondary to malunion of the clavicle that was treated by an anterior and middle scalenectomy without a rib resection.

Keyword

Clavicle; Malunion; Thoracic outlet syndrome; Scalenetomy

MeSH Terms

Adult
Humans
Low Back Pain/etiology
Lumbar Vertebrae/surgery
Male
Postoperative Complications/*microbiology
Spondylitis/etiology/*microbiology
Thoracic Vertebrae/*microbiology/pathology
Tuberculosis/drug therapy/*microbiology
Tuberculosis, Spinal/complications/drug therapy/*microbiology
Adult
Clavicle/*injuries
Fractures, Malunited/*complications
Humans
Male
Thoracic Outlet Syndrome/etiology/radiography/*surgery

Figure

• 

  Fig. 1 Anteroposterior radiograph of the left clavicle 9 months after the injury. A typical clavicular malunion deformity resulting from that the proximal fragment was displaced superiorly, while the distal fragment was displaced inferiorly, translated medially, and rotated anteriorly after the midshaft clavicular fracture, is demonstrated.

• 

  Fig. 2 Coronal T2-weighted magnetic resonance images of the left brachial plexus. (A) The preoperative image shows that the left brachial plexus was compressed by the malunited clavicle in the costoclavicular space. (B) The postoperative image at the follow-up performed 16 months after surgery shows that the distorted brachial plexus lined up in a straight line in contrast to the alignment observed before surgery.

• 

  Fig. 3 Schematic diagram of a supraclavicular scalenectomy. After exposing the anterior and middle scalene muscles and brachial plexus via the supraclavicular approach, the distal part of the anterior scalene muscle was divided completely followed by a middle scalenectomy.

Reference

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