Clavicle fractures are common injuries, but delayed union with secondary brachial plexopathy is a rare and debilitating condition that poses unique diagnostic and therapeutic challenges.
This case report highlights the comprehensive management of a 59-year-old male who presented with an 8-week-old delayed union of right clavicle midshaft fracture and an ipsilateral scapula body fracture, also known as floating shoulder (Fig.1,2). The patient was conservatively managed elsewhere when the patient developed right upper limb plexopathy three weeks post-injury. The patient presented at Kauvery hospital in the eighth week post-injury, with monoparesis and paraesthesia primarily affecting C8 and T1 motor functions, along with sensory deficits in the C6-C8 dermatomes.
Preoperative imaging studies, including CT and MRI, revealed hypertrophic callus and granulation tissue compressing the brachial plexus without structural disruption. Nerve conduction studies confirmed compressive brachial plexopathy. Surgical intervention involved exploration and decompression of the brachial plexus by plastic surgeon along with excision of granulation tissue, and internal fixation of the clavicle using a locking plate by orthopaedic surgeon team. Intraoperative nerve stimulation confirmed intact motor function at the end of decompression.
The procedure lasted 90 minutes with a blood loss of 120 ml. Fracture union was noted in radiological imaging within 4 weeks of intervention (Fig.3). Postoperative rehabilitation included intensive physiotherapy, which facilitated complete neurological recovery within nine weeks.
This case emphasizes the need for a multidisciplinary approach in managing delayed union of the clavicle with brachial plexopathy. Early surgical decompression and fixation are critical for promoting fracture healing, restoring nerve function, and ensuring functional recovery. Timely intervention, combined with comprehensive rehabilitation, can significantly improve outcomes in patients with this rare condition.
This case emphasizes the need for a multidisciplinary approach in managing delayed union of the clavicle with brachial plexopathy. Early surgical decompression and fixation are critical for promoting fracture healing, restoring nerve function, and ensuring functional recovery. Timely intervention, combined with comprehensive rehabilitation, can significantly improve outcomes in patients with this rare condition.
Fig.1 : CT reconstructed image showing right clavicle fracture
Fig.2 : CT reconstructed image in PA view showing right floating shoulder
Fig.3 : postoperative X-ray image showing signs of bone healing
Orthopaedic doctors team –
Dr. Aravindan Selvaraj
Dr. Keerthivasan.P
Dr. William Abraham
Plastic Surgeon – Dr. Sathish Manivel
Author –
Dr. Mirunaalini Thangavelan
Postgraduate
Kauvery Hospital, Chennai
Mentors –
Dr. P. Keerthivasan
Consultant Orthopaedic Spine Surgeon
Kauvery Hospital, Chennai
Dr. Mukunth K
Senior Consultant Orthopedic Surgeon
Kauvery Hospital, Chennai