Conservative treatment for brachial plexus injury after a displaced clavicle fracture: a case report and literature review

Abstract

Background: A brachial plexus injury is a rare complication of clavicle fractures. Previous case reports only examined the surgical outcomes of brachial plexus injuries that occurred after a clavicle fracture and did not report on the outcomes of conservative treatment. In this report, we present the prognosis of a patient with an acute displaced clavicle fracture accompanied by a brachial plexus injury that was conservatively treated. Case presentation: A 51-year-old man with a middle-third clavicle fracture due to a direct trauma after falling down the stairs. A brachial plexus injury experienced symptoms, including numbness occurred in the affected upper extremity, at 1 day after the injury. The patient’s motor power in the elbow, wrist, and hand decreased at 3 days after the injury. Magnetic resonance imaging (MRI) showed no loss of continuity in the brachial plexus, but showed nerve compression by displaced fracture fragments. Electromyography revealed brachial plexopathy. Conservative treatment, including a shoulder sling, was performed with satisfactory outcomes; the patient reported a 70% improvement at 6 months after the injury. Conclusions: A brachial plexus injury is a rare complication of clavicle fractures that can cause serious dysfunction of the upper extremities affected by the injury. Conservative treatment may be considered for acute nerve compression by displaced fracture fragments rather than extensive callus or granulation tissue formation to achieve a satisfactory recovery in young patients. MRI should typically be performed before making a treatment decision to examine the brachial plexus for any discontinuity or kinking.