Abstract
A 25-year-old female patient complained of intermittent pseudoradicular,
ulnar-accentuated tingling paraesthesias of the right arm, accompanied by swelling
and
cyanotic skin discolouration of the forearm 9 days following plate osteosynthesis
of a
clavicle shaft fracture in the middle third (OTA classification type B). CT angiography
revealed almost complete obstruction of the lumen of the subclavian vein at the
junction
between the clavicle and the first rib, which was consistent with a thoracic inlet
syndrome. This was triggered by a haematoma of the concomitantly fractured first
rib and
a cortical screw protrusion in the area of the constriction between the clavicle
and the
first rib. Revascularisation was achieved by evacuating the fracture haematoma,
partial
resection of the first rib, and replacement of the two protruding screws. This
case
demonstrates that screw protrusion must be avoided during plate osteosynthesis
of
clavicle shaft fractures, particularly in the medial third of the clavicle – due
to its
proximity to the first rib. Injuries to the subclavicular neurovascular bundle
can be
comprehensively detected and treated by resection of the first rib.
Keywords
clavicle fracture - thoracic inlet syndrome - rib resection
