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.
Highlights
Thoracic outlet syndrome (TOS) is a collection of upper extremity symptoms, such as pain, weakness, paresthesia, and pallor, which is caused by compression of the brachial plexus and subclavian vessels in the thoracic outlet
We report a case of late TOS after a clavicle fracture associated with multiple trauma, in which the cause might be due to the common situation that patients with multiple trauma including a clavicle fracture, are necessarily treated conservatively without a figure-of-8 bandage because of the need for complete supine bed rest
In patients with multiple trauma, including clavicle fractures, the clavicle fracture may have to be necessarily treated conservatively according to the treatment for other more severe injuries, and our patient underwent conservative treatment for the clavicle fracture during 3 weeks of complete bed rest for other injuries
Summary
Thoracic outlet syndrome (TOS) is a collection of upper extremity symptoms, such as pain, weakness, paresthesia, and pallor, which is caused by compression of the brachial plexus and subclavian vessels in the thoracic outlet. In contrast to clavicle fractures, TOS as a complication is a severe condition because of the necessity of surgical treatment and possible poor outcome that includes residual upper extremity symptoms [3]. We report a case of late TOS after a clavicle fracture associated with multiple trauma, in which the cause might be due to the common situation. That patients with multiple trauma including a clavicle fracture, are necessarily treated conservatively without a figure-of-8 bandage because of the need for complete supine bed rest. This case suggests a pitfall of the conservative treatment of clavicle fractures, resulting in the severe complication of late TOS. The patients gave the informed consent prior being included into the study
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