Late Presentation of Brachial Plexus Traction Injury After Fixation of Chronic Clavicle Nonunion Mimicking Brachial Plexitis: A Case Report and Literature Review

TL;DR

A man developed nerve issues after clavicle surgery, and this case study explores whether it was due to a surgical complication or a separate nerve condition.

Contribution

This case highlights a rare iatrogenic brachial plexus injury misdiagnosed as brachial plexopathy, offering insights into surgical decision-making and long-term outcomes.

Findings

Neuromotor deficits worsened after a second clavicle surgery, suggesting iatrogenic nerve injury.

A 7-year follow-up showed recovery patterns inconsistent with typical brachial plexopathy.

The case emphasizes the importance of considering surgical complications in postoperative nerve dysfunction.

Abstract

We report the case of a healthy 56-year-old male who developed severe neuromotor deficits of his upper extremity after two surgeries for a chronic clavicle fracture nonunion. Initial reconstruction with plate fixation achieved anatomic alignment. Twelve days later, diffuse numbness and weakness developed in his ipsilateral hand. A second (and final) clavicle surgery was then performed to increase the subclavicular space, after which his neuromotor deficits dramatically worsened. Because brachial plexopathy, specifically Parsonage-Turner syndrome (PTS), was considered the most likely diagnosis, no further clavicle or brachial plexus surgery was performed, as this would likely not alter the course of this inflammatory condition. Retrospective analysis suggests that iatrogenic nerve traction injury was the most likely cause of the deficits, rather than brachial plexopathy/PTS. The initial 12-day delay in symptom onset was perplexing and created diagnostic uncertainty. We report this intriguing case to: (1) discuss this diagnostic dilemma in the context of a literature review of the two competing diagnoses and the surgical and non-surgical decisions that were made, and (2) provide details of the patient’s recovery over seven years. These findings offer valuable considerations and clinical data for clinicians and surgeons tasked with managing patients with significant neuromotor complications after clavicle fracture surgery.

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