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Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture

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...

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Autores principales: Rosati, Marco, Andreani, Lorenzo, Poggetti, Andrea, Zampa, Virna, Parchi, Paolo, Lisanti, Michele
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Indian Orthopaedic Research Group 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4719249/
https://www.ncbi.nlm.nih.gov/pubmed/27298912
http://dx.doi.org/10.13107/jocr.2250-0685.109
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author Rosati, Marco
Andreani, Lorenzo
Poggetti, Andrea
Zampa, Virna
Parchi, Paolo
Lisanti, Michele
author_facet Rosati, Marco
Andreani, Lorenzo
Poggetti, Andrea
Zampa, Virna
Parchi, Paolo
Lisanti, Michele
author_sort Rosati, Marco
collection PubMed
description 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.
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spelling pubmed-47192492016-06-13 Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture Rosati, Marco Andreani, Lorenzo Poggetti, Andrea Zampa, Virna Parchi, Paolo Lisanti, Michele J Orthop Case Reports Case Report 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. Indian Orthopaedic Research Group 2013 /pmc/articles/PMC4719249/ /pubmed/27298912 http://dx.doi.org/10.13107/jocr.2250-0685.109 Text en Copyright: © Indian Orthopaedic Research Group http://creativecommons.org/licenses/by-nc-sa/3.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc-sa/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Rosati, Marco
Andreani, Lorenzo
Poggetti, Andrea
Zampa, Virna
Parchi, Paolo
Lisanti, Michele
Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture
title Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture
title_full Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture
title_fullStr Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture
title_full_unstemmed Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture
title_short Progressive Brachial Plexus Palsy after Osteosynthesis of an Inveterate Clavicular Fracture
title_sort progressive brachial plexus palsy after osteosynthesis of an inveterate clavicular fracture
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4719249/
https://www.ncbi.nlm.nih.gov/pubmed/27298912
http://dx.doi.org/10.13107/jocr.2250-0685.109
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