Iatrogenic thoracic outlet syndrome caused by revision surgery for multiple subacute fixation failures of a clavicle fracture: a case report.

During revision surgical fixation of clavicle fractures and fracture nonunions, compression of the prominent neurovascular structures of the thoracic outlet can be an important potential complication. In this report, we describe the case of a manual laborer who had iatrogenic compression of the thoracic outlet of his dominant arm by fracture callus during revision surgery after multiple subacute fixation failures. The surgeon initially failed to recognize that the anatomic alignment of the clavicle fracture during osteosynthesis had resulted in thoracic outlet syndrome (TOS), as definitively established by venogram 14 days postoperatively. This case illustrates how the constellation of signs and symptoms can be misleading when this problem occurs in a subacute setting. A number case reports have described iatrogenic TOS in the setting of a midshaft clavicle fracture associated with nonunions, malunions, and delayed diagnosis. This report is significant because it addresses a case of iatrogenic TOS accompanied by (1) multiple subacute failures of surgical fixation before final/definitive fixation, all within 60 days of the fracture, (2) description of the patient’s clinical findings and diagnostic studies that ultimately led to a venogram and revision surgery, and (3) quantification of patient function and satisfaction for nearly 5 years to definitively establish whether decompression surgery for TOS would be required.