J Korean Fract Soc.  2019 Apr;32(2):97-101. 10.12671/jkfs.2019.32.2.97.

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

• Jin HK
• Park KB
• Cho HL
• Kang JI
• Lee WS

• KMID: 2443111
• DOI: http://doi.org/10.12671/jkfs.2019.32.2.97

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.

Keyword

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

MeSH Terms

Bony Callus
Brachial Plexus Neuropathies
Brachial Plexus*
Clavicle*
Paralysis*
Thoracic Outlet Syndrome

Figure

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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).

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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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