Peripheral Nerve Injury Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
Bone Joint J. 2013 Jan;95-B(1):106-10. doi: 10.1302/0301-620X.95B1.29625.
We present our experience of managing patients with iatropathic brachial plexus injury after delayed fixation of a fracture of the clavicle. It is a retrospective cohort study of patients treated at our peripheral nerve injury unit and a single illustrative case report. We identified 21 patients in whom a brachial plexus injury occurred as a direct consequence of fixation of a fracture of the clavicle between September 2000 and September 2011.The predominant injury involved the C5/C6 nerves, upper trunk, lateral cord and the suprascapular nerve. In all patients, the injured nerve was found to be tethered to the under surface of the clavicle by scar tissue at the site of the fracture and was usually associated with pathognomonic neuropathic pain and paralysis.Delayed fixation of a fracture of the clavicle, especially between two and four weeks after injury, can result in iatropathic brachial plexus injury. The risk can be reduced by thorough release of the tissues from the inferior surface of the clavicle before mobilisation of the fracture fragments. If features of nerve damage appear post-operatively urgent specialist referral is recommended.
我们介绍了我们在锁骨骨折延迟固定后管理医源性臂丛神经损伤患者的经验。这是一项对我们周围神经损伤单位治疗的患者进行的回顾性队列研究和一个单独的案例报告。我们在 2000 年 9 月至 2011 年 9 月期间发现了 21 例因锁骨骨折固定而直接导致臂丛神经损伤的患者。主要损伤涉及 C5/C6 神经、上干、外侧束和肩胛上神经。在所有患者中，受伤的神经都被发现被骨折部位的疤痕组织牵制在锁骨的下表面，通常与特征性的神经病理性疼痛和瘫痪有关。锁骨骨折延迟固定，特别是在受伤后两到四周，可导致医源性臂丛神经损伤。通过在移动骨折碎片之前彻底松解锁骨下表面的组织，可以降低风险。如果术后出现神经损伤的特征，建议立即转介给专家。
