Purpose: Injury to the clavicle is a rare cause of outlet syndrome. We report eight cases to determine the diagnostic and therapeutic features and report outcomes.
Material and methods: This series of eight patients (five women and three men), mean age 48 years ( 1 1 )70) suffcrred from pain irradiating to the upper limb wuh paraesthcsia in the ulnar teritorry of the hand together with diminished muscle force.The diagnosis was established 23.1 months (mean, range 1-10 years) after the initial comminutive mid-third fracture. The displaced hone which was treated orthopaedically. Standard x-rays revealed: four deformed calluses, two atrophie nonunions, one fracture with a vertical fragment (rapid osteosynthesis performed to avoid acute plexus compression) and linally one resection of the mid third (secondary to osteitis). The eleelromyogram confirmed the diagnosis, generally with compression of a secondary anteromcdial trunk. 3D reconstruction scans (measurement of the eostocleidal space) were obtained.
Results: Pain disappeared the day after surgery as did the paraesthesia in seven out of eight patients. The clavicle healed in 13 to IH months.
Discussion: Different mechanisms can cause compression of the brachial plexus after displaced comminutive fracture of the clavicle. Different therapeutic modalities have been proposed. The outlet syndrome should be considered following displaced fractures of the mid third of the clavicle in patients presenting pain irradiating to the upper limb. The diagnosis is confirmed by elcctromyography. Proper analysis of the clavicle is obtained with 3D CT scan allowing adapted surgical treatment.
P. Valenti, S. Naser Chourif. A. Gilbert
Institut de la Main, Clinique Jouvenet, 6, square
Jouvenet, 75016 Paris, France
Copyright British Editorial Society of Bone & Joint Surgery 2004
Provided by ProQuest Information and Learning Company. All rights Reserved
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