Late Thoracic Outlet Syndrome after Clavicle Fractures in Patients with Multiple Trauma: A Pitfall of Conservative Treatment

Daichi Ishimaru, Hiroyasu Ogawa, Hiroshi Sumi, Katsuji Shimizu

Department of Orthopaedic Surgery, Graduate School of Medicine, Gifu University Yanagido, Gifu, Japan.
Department of Orthopaedic Surgery, Sumi Memorial Hospital, Shirotori, Gifu, Japan.

DOI: 10.4236/ojo.2012.23018                

Abstract

Late thoracic outlet syndrome is a rare complication of clavicle fractures and usually warrants surgical treatment though its cause of clavicle fractures are a common injury and in most cases are treated conservatively. We report a case of a clavicle fracture accompanying severe multiple trauma, which was necessarily treated conservatively because of the severe associated injuries of the patient. The patient was unable to wear a figure-of-8 bandage for the fracture because of the need for complete supine bed rest, due to his other injuries. In this common situation, the clavicle fracture shortened and eventually resulted in the late thoracic outlet syndrome. We believe the cause of this was because a figure-of-8 bandage could not be applied due to the need for complete supine bed rest, and thus was inevitable because of his general condition. This case suggests that the conservative treatment of clavicle fractures, where there is the need for complete bed rest, potentially induces late thoracic outlet syndrome, and that this is indeed a pitfall in the treatment of clavicle fractures in multiple trauma.

Keywords

Clavicle Fracture; Thoracic Outlet Syndrome; Complication; Multiple Trauma

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	D. J. Chen, D. C. Chuang and F. C. Wei, “Unusual Thoracic Outlet Syndrome Secondary to Fractured Clavicle,” Journal of Trauma, Vol. 52, No. 2, 2002, pp. 393-398. doi:10.1097/00005373-200202000-00033
[2]	K. Fujita, K. Matsuda, Y. Sakai, H. Sakai and K. Mizuno, “Late Thoracic Outlet Syndrome Secondary to Malunion of the Fractured Clavicle: Case Report and Review of the Literature,” Journal of Trauma, Vol. 50, No. 2, 2001, pp. 332-335. doi:10.1097/00005373-200102000-00022
[3]	C. K. Kitsis, A. J. Marino, S. J. Krikler and R. Birch, “Late Complications Following Clavicular Fractures and Their Operative Management,” Injury, Vol. 34, No. 1, 2003, pp. 69-74. doi:10.1016/S0020-1383(02)00169-9
[4]	C. Faldini, M. Nanni, D. Leonetti, F. Acri, C. Galante, D. Luciani and S. Giannini, “Nonoperative Treatment of Closed Displaced Midshaft Clavicle Fractures,” Journal of Orthopaedics and Traumatology, Vol. 11, No. 4, 2010, pp. 229-236. doi:10.1007/s10195-010-0113-z
[5]	A. Nordqvist, C. J. Petersson and I. Redlund-Johnell, “Mid- Clavicle Fractures in Adults: End Result Study after Conservative Treatment,” Journal of Orthopaedics and Traumatology, Vol. 12, No. 8, 2008, pp. 572-576. doi:10.1097/00005131-199811000-00008
[6]	C. M. Robinson, “Fractures of the Clavicle in the Adult. Epidemiology and Classification,” The Journal of Bone & Joint Surgery of British, Vol. 80, No. 3, 1998, pp. 476- 484. doi:10.1302/0301-620X.80B3.8079
[7]	J. F. Connolly and M. Ganjianpour, “Thoracic Outlet Syndrome Treated by Double Osteotomy of a Clavicular Malunion: A Case Report,” The Journal of Bone & Joint Surgery of American, Vol. 84, No. 3, 2002, pp. 437-440.
[8]	J. G. Skedros, B. B. Hill and T. C. Pitts, “Iatrogenic Thoracic Outlet Syndrome Caused by Revision Surgery for Multiple Subacute Fixation Failures of a Clavicle Fracture: A Case Report,” Journal of Shoulder and Elbow Surgery, Vol. 19, No. 1, 2010, pp. e18-e23. doi:10.1016/j.jse.2009.05.014
[9]	H. P. Gottschalk, R. H. Browne and A. J. Starr, “Shoulder Girdle: Patterns of Trauma and Associated Injuries,” Journal of Orthopaedics and Traumatology, Vol. 25, No. 5, 2011, pp. 266-271. doi:10.1097/BOT.0b013e3181e47975
[10]	C. Neer, “Fractures of the Clavicle,” In: C. A. Rockwood Jr. and D. P. Green, Eds., Fractures in Adults, 2nd Edition, Lippincott, Philadelphia, 1984, pp. 707-713.
[11]	M. Ledger, N. Leeks, T. Ackland and A. Wang, “Short Malunions of the Clavicle: An Anatomic and Functional Study,” Journal of Shoulder and Elbow Surgery, Vol. 14, No. 4, 2005, pp. 349-354. doi:10.1016/j.jse.2004.09.011
[12]	J. M. Hill, M. H. McGuire and L. A. Crosby, “Closed Treatment of Displaced Middle-Third Fractures of the Clavicle Gives Poor Results,” The Journal of Bone & Joint Surgery of British, Vol. 79, No. 4, 1997, pp. 537- 539. doi:10.1302/0301-620X.79B4.7529