Transient Brachial Plexopathy After Fixation of a Clavicle Fracture Nonunion

Abstract

Case: A 54-year-old man presented with a comminuted left midclavicle fracture that progressed to a symptomatic nonunion after nonsurgical management. Nonunion open reduction and internal fixation (ORIF) was performed, but a left brachial plexopathy developed 48 hours postoperatively. Imaging failed to demonstrate an emergent cause. The patient was monitored and completely recovered, with occasional neuralgia and mildly limited forward elevation of the shoulder. Conclusion: Development of a brachial plexopathy 48 hours after routine clavicle nonunion ORIF using plate fixation is an unusual complication. Future studies are needed to determine if this “wait-and-see” approach can be generalized to similar cases.

Acute brachial plexopathy secondary to surgical management of an atrophic nonunion of a clavicle fracture

“…In the case of an atrophic or oligotrophic non-union, plexopathy is usually secondary to a traction phenomenon caused by elongation of the plexus while correcting the anatomical length of the clavicle. Johnson et al [ 3 ] described the case of a 54-year-old patient with an atrophic non-union of a midshaft clavicle fracture. Within 48 h of the surgery (open reduction, fixation, and grafting), the patient developed paresthesias and progressive neurological symptoms.…”

“…The diagnostic approach documented in the published case reports includes the use of imaging studies such as Computed Tomography Angiography and MRI of the plexus [ 3 , [5] , [6] , [7] ] to rule out the presence of potential acute post-surgical compressive etiologies (hematomas, pseudoaneurysms, or issues related to the osteosynthesis material). However, in the cases reviewed, the plexopathy was not secondary to a cause other than those mentioned (compression by hypertrophic callus or traction on the plexus).…”

“…Surgical treatment of a symptomatic nonunion through open reduction and grafting is a procedure with satisfactory outcomes; however, the frequency of associated complications is close to 17 % [ 9 ], the vast majority related to cutaneous irritation from the hardware, superficial infections, and healing failure. Few case reports have been published on acute postsurgical brachial plexopathies following the treatment of a clavicle nonunion [ 3 , 7 ].…”