Brachial plexopathy due to subclavian artery pseudoaneurysm secondary to comminuted clavicle shaft fracture: A case report

In adults, brachial plexopathy due to clavicle fractures is rare and is most commonly caused by nonunion, mal-united fragments, hypertrophic callus, or pseudoaneurysm of the subclavian artery or vein. Conservative treatment of nondisplaced and displaced clavicle shaft fractures in adults usually produces satisfactory outcomes. This article presents a case of a 82-year-old man who sustained a closed, comminuted midshaft left clavicle fracture complicated by brachial plexus injury secondary to pseudoaneurysm of the left subclavian artery. Initially, the fracture was treated conservatively. However, he returned 5 days later with left brachial plexopathy. Computed tomography angiogram confirmed left subclavian artery pseudoaneurysm secondary to the fracture. The patient had endovascular stenting of the left subclavian artery to exclude the aneurysm. 12 weeks later, he had malunited clavicle and no improvement in brachial plexus function. 16 weeks after the injury, he had left brachial plexus exploration, decompression and open reduction and internal fixation of his left clavicle mal-united fracture. 4 weeks post operative, patient started to develop signs suggestive of significant re-innervation.