Brachial plexus paralysis in a patient with clavicular fracture, medico-legal implications

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Stefania Fozzato
Quirino Alessandro Petrucci
Alberto Passeri
Luca Bianco Prevot
Riccardo Accetta
Giuseppe Basile

Keywords

brachial plexus injury, paralysis, clavicular fracture, neurological deficits, medico-legal implications.

Abstract

Clavicular fractures make up 2.6-4% of all fractures in adults. The most frequent mechanism of injury is a fall with direct trauma to the shoulder during sports or road accidents.


These fractures can have acute complications such as vascular lesions, nerve injuries, pneumothorax, and musculoskeletal injury. Primary brachial plexus injuries are rare events, both in the adult and paediatric population, have an incidence of less than 1% and are usually caused by direct compression of the fragments.


We describe a case of midshaft clavicular fracture treated conservatively with a figure-eight bandage, associated with acute brachial plexus injury, and possible medico-legal repercussions thereof. It is important to recognize the progression of neurological deficits early on, in order for appropriate treatment to be undertaken promptly. Patients must be monitored and re-evaluated within few days after the injury to check the correct positioning of the brace, its degree of tolerability, and the possible onset of neurological deficits, because some clavicular fractures can be associated with compression of the brachial plexus.

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