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Intraoperative Neuromonitoring for Brachial Plexus Neurolysis During Delayed Fixation of a Clavicular Fracture Presenting as Thoracic Outlet Syndrome

A Case Report

Ashman, Bradley D., MD, FRCSC1; Tewari, Anurag, MD2; Castle, Joshua, REEG/EPT, CNIM2; Hasan, Samer S., MD, PhD1; Bhatia, Sanjeev, MD1

doi: 10.2106/JBJS.CC.18.00040
Case Reports

Case: Brachial plexopathy is a rare complication of nonoperatively treated clavicular fractures. We describe a 68-year-old man who presented with fracture-callus-induced acute brachial plexopathy and dynamic thoracic outlet syndrome after 9 weeks of nonoperative management for a clavicular fracture. He underwent fracture fixation with brachial plexus decompression via callus excision; intraoperative neuromonitoring was used to evaluate brachial plexus function. Postsurgery, his neurologic function recovered completely.

Conclusion: Intraoperative neuromonitoring is a useful tool for minimizing the risk of additional brachial plexus injury and determining the adequacy of neural decompression during delayed open reduction and internal fixation of clavicular fractures with fracture-callus-induced brachial plexus compression.

1Mercy Health—Cincinnati Sports Medicine and Orthopaedic Center, Cincinnati, Ohio

2Evokes, LLC, Mason, Ohio

E-mail address for B.D. Ashman:

Copyright © 2018 by The Journal of Bone and Joint Surgery, Incorporated
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