Abstract
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 (11)70) sufferred from pain irradiating to the upper limb with paraesthesia 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 bone which was treated orthopaedically. Standard x-rays revealed: four deformed calluses, two atrophic nonunions, one fracture with a vertical fragment (rapid osteosynthesis performed to avoid acute plexus compression) and finally one resection of the mid third (secondary to osteitis). The electromyogram confirmed the diagnosis, generally with compression of a secondary anteromedial trunk. 3D reconstruction scans (measurement of the costo-cleidal 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 18 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 electromyography. Proper analysis of the clavicle is obtained with 3D CT scan allowing adapted surgical treatment.
The abstracts were prepared by Docteur Jean Barthas. Correspondence should be addressed to him at Secrétariat de la Société S.O.F.C.O.T., 56 rue Boissonade, 75014 Paris.
