Stella Marco, Santolini Emmanuele, Briano Stefania, Santolini Federico
Orthopaedic and Trauma Unit, Department of Emergency, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
Orthopaedic and Trauma Unit, Department of Emergency, IRCCS AOU San Martino - IST, Largo Rosanna Benzi 10, 16132 Genoa, Italy.
Injury. 2015 Dec;46 Suppl 7:S3-7. doi: 10.1016/S0020-1383(15)30035-8.
A 74-year-old woman was referred to our hospital due to recurrent episodes of upper limb ischemia. Her past medical history included a clavicle non-union developed after a clavicle midshaft fracture that had occurred 30 years previously. After a long asymptomatic period, she started showing symptoms of chronic ischemia to the left arm that were misdiagnosed. Thoracic outlet syndrome (TOS) is a rare but possible complication of mal-union and non-union of clavicle fractures; symptoms related to arterial involvement (ATOS) amount to less than 1% of all existing forms of thoracic outlet syndrome. In case of clavicle non-union, local instability plays a key role in determining the initial injury to the vessels and the recurrence of symptoms. Restoration of local bone stability and anatomy, obtained by compression plating and autologous bone grafting, combined with an appropriate vascular surgery, is essential to achieve a clinical resolution of symptoms and to avoid the recurrence of symptomatology as seen in the herein case.
一名74岁女性因上肢缺血反复发作被转诊至我院。她的既往病史包括30年前发生的锁骨中段骨折后出现的锁骨不愈合。经过漫长的无症状期后，她开始出现左臂慢性缺血症状，但被误诊。胸廓出口综合征（TOS）是锁骨骨折畸形愈合和不愈合的一种罕见但可能出现的并发症；与动脉受累相关的症状（ATOS）在所有胸廓出口综合征现有类型中占比不到1%。在锁骨不愈合的情况下，局部不稳定在决定血管的初始损伤和症状复发方面起关键作用。通过加压钢板固定和自体骨移植恢复局部骨稳定性和解剖结构，并结合适当的血管手术，对于实现症状的临床缓解以及避免像本例所见的症状复发至关重要。
