Brachial Plexus Palsy After Intramedullary Fixation of a Clavicular Fracture: A Report of Three Cases

Abstract

D isplaced comminuted fractures of the clavicle are associated with an approximately 5% to 10% prevalence of nonunion1-5, and malunion (particularly when associated with >2 cm of shortening) can affect shoulder function1,6-9. While nonoperative treatment of clavicular fractures leads to excellent shoulder function in the vast majority of patients5, some patients with potentially problematic displaced and comminuted fractures now request operative treatment. Intramedullary fixation of the fractured clavicle is recognized as a well-established method of treatment10-14. The present report describes the cases of three patients in whom a brachial plexus palsy developed after intramedullary fixation of a displaced clavicular fracture; to our knowledge, this complication has not been described previously. The patients were informed that data concerning their cases would be submitted for publication. ### Patients T wo surgeons managed twenty patients with intramedullary rod fixation for the treatment of a clavicular fracture over a three-year period. Three of these patients had development of a brachial plexus palsy. All three patients had a normal preoperative neurological examination. The first patient (Case 1) was a sixty-nine-year-old healthy female homemaker who fell while descending stairs and sustained a mid-diaphyseal oblique fracture of the left (nondominant) clavicle that was completely displaced. Radiographs made four weeks after the injury showed no signs of healing. The patient was very unhappy with the pain and crepitation associated with motion at the fracture site, and she requested operative fixation. The second patient (Case 2) was a thirty-six-year-old man who fell and sustained a mid-diaphyseal oblique fracture of the left (nondominant) clavicle that was completely displaced. Radiographs made four weeks after the injury showed no signs of healing (Fig. 1-A). The patient was unhappy with the deformity of the shoulder, and he requested operative …