Brachial Plexus Injury Significantly Increases Risk of Axillosubclavian Vessel Injury in Blunt Trauma Patients With Clavicle Fractures

Background A national analysis of clavicle fractures is lacking and the risk of concomitant axillosubclavian vessel injury (ASVI) in patients with clavicle fractures is unknown. A minority of patients may have a combined brachial plexus injury (BPI). We sought to describe risk factors for concomitant ASVI in patients with a clavicle fracture; hypothesizing patients with combined clavicle fracture and BPI has a higher risk of ASVI. Methods The Trauma Quality Improvement Program (2010-2016) was queried for blunt trauma patients with a clavicle fracture. A multivariable logistic regression model was used to determine risk factors for ASVI. A subset analysis on patients with isolated clavicle fractures was additionally performed. Results From 59 198 patients with clavicle fractures, 341 (.6%) had concomitant ASVI. Compared to patients without ASVI, patients with ASVI had a higher median injury severity score (24 vs. 17, P < .001) and rates of pulmonary contusions (43.4% vs. 37.7%, P = .029) and BPI (18.2% vs. .4%, P < .001). After controlling for associated chest wall injuries and humerus fracture, the BPI odds ratio (OR 49.17, 35.59-67.92, P < .001) was independently associated with risk for ASVI. In a subset analysis of isolated clavicle fractures, BPI remained associated with risk of ASVI (OR 60.01, confidence intervals 25.29-142.39, P < .001). Conclusion The rate of concomitant ASVI in patients with a clavicle fracture is <1%. Patients presenting with a clavicle fracture had a high rate of injuries including pulmonary contusion. Patients with findings suggestive of underlying BPI had a nearly 50 times increased associated risk of ASVI. Thus, a detailed physical exam in this setting including brachial-brachial index appears warranted.

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Risk factors for clavicle fracture concurrent with brachial plexus injury

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-015-3917-5 ◽

2015 ◽

Vol 293 (4) ◽

pp. 783-787 ◽

Cited By ~ 4

Author(s):

Ertugrul Karahanoglu ◽

Taner Kasapoglu ◽

Safak Ozdemirci ◽

Erdem Fadıloglu ◽

Aysegul Akyol ◽

...

Keyword(s):

Risk Factors ◽

Brachial Plexus ◽

Brachial Plexus Injury ◽

Clavicle Fracture

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

Annals of The Royal College of Surgeons of England ◽

10.1308/003588413x13511609955256 ◽

2013 ◽

Vol 95 (2) ◽

pp. e6-e9 ◽

Cited By ~ 3

Author(s):

I Gill ◽

J Quayle ◽

M Fox

Keyword(s):

Brachial Plexus ◽

Subclavian Artery ◽

Brachial Plexus Injury ◽

Clavicle Fracture ◽

High Energy ◽

Low Energy ◽

Unique Case ◽

Vascular Disruption ◽

Clavicle Fractures ◽

Neurological Injuries

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, >2cm 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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A retrospective analysis of risk factors for clavicle fractures in newborns with shoulder dystocia and brachial plexus injury: A single-center experience

Acta Orthopaedica et Traumatologica Turcica ◽

10.5152/j.aott.2020.19180 ◽

2020 ◽

Vol 54 (6) ◽

pp. 609-613

Author(s):

Ali Erkan Yenigul ◽

◽

Nefise Nazli Yenigul ◽

Emre Baser ◽

Runa Ozelci ◽

...

Keyword(s):

Risk Factors ◽

Brachial Plexus ◽

Retrospective Analysis ◽

Brachial Plexus Injury ◽

Shoulder Dystocia ◽

Single Center ◽

Single Center Experience ◽

Clavicle Fractures

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Brachial plexus injury after clavicle fracture operation: a case report and literature review

BMC Surgery ◽

10.1186/s12893-021-01335-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhenyu Cao ◽

Yufei Hou ◽

Xiaochen Su ◽

Menghao Teng ◽

Wenchen Ji ◽

...

Keyword(s):

Brachial Plexus ◽

Upper Limb ◽

Brachial Plexus Injury ◽

Clavicle Fracture ◽

Symptomatic Treatment ◽

Movement Restriction ◽

Functional Exercise ◽

Clavicle Fractures ◽

The Right ◽

Upper Limb Dysfunction

Abstract Background Open reduction and internal fixation (ORIF) is the preferred choice for treating clavicle fractures. The brachial plexus injury caused by ORIF of a clavicle fracture is very rare. If it is not treated in time, the function of the brachial plexus will be challenging to recover, which will eventually lead to upper limb dysfunction and seriously affect the patient’s quality of life. Our team recently used ORIF to treat a patient with a clavicle fracture, who developed brachial plexus injury symptoms after surgery. Case presentation A 34-year-old female patient was admitted to the hospital for 13 h due to the right shoulder movement restriction after a fall. Due to the significant displacement of the fracture, we used ORIF to treat the fracture. The surgery went well. When the anaesthesia effect subsided 12 h after the operation, the patient developed right brachial plexus injury symptoms, decreased right upper limb muscle strength, dysfunction, and hypoesthesia. Symptomatic treatments, such as nourishing nerve and electrical stimulation, were given immediately. Sixty days after the operation, the patient’s brachial plexus injury symptoms disappeared, and the function of the right upper limb returned to the preoperative state. Conclusions Patients with clavicle fractures usually need to undergo a careful physical examination before surgery to determine whether symptoms of brachial plexus injury have occurred. Anaesthesia puncture requires ultrasound guidance to avoid direct damage to the brachial plexus. When the fracture end is sharp, reset should be careful to prevent nerve stump stabbed. When using an electric drill to drill holes, a depth limiter should be installed in advance to prevent the drill from damaging the subclavian nerve and blood vessels. When measuring the screw depth, the measuring instrument should be close to the bone surface and sink slowly to avoid intense hooks and damage to the brachial plexus. Try to avoid unipolar electrosurgical units to prevent heat conduction from damaging nerves, and bipolar electrocoagulation should be used instead. If symptoms of brachial plexus injury occur after surgery, initial symptomatic treatment is drugs and functional exercise, and if necessary, perform surgical exploration.

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