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Acute Dynamic Thoracic Outlet Syndrome After Midshaft Clavicular Osteosynthesis for NonunionA Case Report
Jason M. Jennings, MD, DPT1; Anil K. Gupta, MD, MBA1; Claude T. Moorman, III, MD2
1 Duke University Medical Center, 200 Trent Drive, Box 3000, Durham, NC 27710. E-mail address for J.M. Jennings: jason.jennings2@duke.edu
2 Duke University Medical Center, 200 Trent Drive, Box 3639, Durham, NC 27710
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Investigation performed at Duke University Medical Center, Durham, North Carolina

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2012 Oct 10;2(4):e58 1-4. doi: 10.2106/JBJS.CC.K.00178
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Clavicular fractures are common, representing 2.6% to 4% of all fractures and 44% of those in the shoulder girdle1,2. Midshaft fractures, which account for approximately 80% of clavicular fractures, historically were treated nonoperatively, even in the presence of substantial displacement2,3. Recent studies have shown that the rate of nonunion with displaced midshaft fractures treated nonoperatively may be as high as 15%3-5. Furthermore, clavicular osteosynthesis is reported to be a safe and reliable treatment of midshaft clavicular fractures, with midshaft nonunion rates as low as 2.2%5. Despite the success of clavicular osteosynthesis, compression of neurovascular structures of the thoracic outlet has been reported as a noteworthy complication6. We describe the results of an osteosynthesis of a clavicular fracture nonunion that resulted in a postoperative acute dynamic thoracic outlet syndrome. In addition, we present an intraoperative diagnostic test that can be performed to avoid such a complication. To our knowledge, there are no previously reported cases of acute dynamic thoracic outlet syndrome following clavicular osteosynthesis for fracture nonunion. The patient was informed that data concerning the case would be submitted for publication, and he provided consent.
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