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Case Reports
. 2013 Mar;95(2):e30-3.
doi: 10.1308/003588413X13511609955256.

A low energy paediatric clavicle fracture associated with acute brachial plexus injury and subclavian artery compression

I Gill  1 , J Quayle, M Fox
Affiliations
Case Reports

A low energy paediatric clavicle fracture associated with acute brachial plexus injury and subclavian artery compression

I Gill et al. Ann R Coll Surg Engl. 2013 Mar.

Abstract

Paediatric clavicle fractures are common injuries presenting to orthopaedic surgeons. The majority of these represent midshaft low energy fractures, which in the vast majority of cases are treated non-operatively and recover rapidly. The main indications to consider operative intervention include high energy of injury, >2 cm shortening, open fractures and associated vascular or neurological injuries. Brachial plexus (BP) injuries are uncommon with variable outcomes. They often result from high energy motorcycle related accidents with potentially fatal associated injuries such as vascular disruption. Their management is complex, requiring expertise, and they are therefore usually managed in supraregional centres. We present a unique case of a low energy midshaft clavicle fracture in a paediatric patient in whom there was an acute BP injury and subclavian artery compression that has not been described previously.

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Figures

Figure 1
Figure 1
Plain x-ray showing midshaft clavicle fracture
Figure 2
Figure 2
Three-dimensional computed tomography reconstruction showing posteriorly directed medial clavicle beneath first rib
Figure 3
Figure 3
Computed tomography angiography showing the medial clavicle (C) compressing the subclavian artery (S) with significantly reduced volume (arrow)
Figure 4
Figure 4
Intraoperative photograph demonstrating the medial portion of clavicle (C) directed posteriorly beneath the first rib (R) compressing trunks of the brachial plexus (arrow)
See this image and copyright information in PMC

References

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