title: Late onset venous thoracic outlet syndrome following clavicle non-union fracture: A case report.
abstract: A 59-year-old woman was admitted three times over a six-month period with recurrent upper extremity deep venous thrombosis (UEDVT). It was determined that this patient was suffering from an unusual presentation of Paget-Schröetter syndrome secondary to a 20-year-old non-union of a midshaft clavicle fracture. Following thrombolysis the patient underwent resection and plate fixation of the clavicle fracture non-union. Despite the anatomic proximity of the subclavian vessels to the clavicle, vascular complications from fracture are rare. Treatment of midshaft clavicle fractures is often non-operative. Non-union rates are generally less than 10%, and easily treated secondarily without complication. Clavicular pseudo-arthroses from trauma have been implicated in the development of the thoracic outlet syndromes, however, onset 20 years after fracture has never before been reported.
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Wong
authors.affiliation: Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Tammy M
authors.initials: TM
authors.lastname: Holm
authors.affiliation: Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: George S M
authors.initials: GS
authors.lastname: Dyer
authors.affiliation: Department of Surgery, Division of Trauma, Burns, and Critical Care, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA JGATES@partners.org.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Gates
mesh_terms: D001860:Bone Plates / Q000009:adverse effects; D002968:Clavicle / Q000601:surgery*; D005260:Female; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D013901:Thoracic Outlet Syndrome / Q000175:diagnosis / Q000601:surgery*; D056824:Upper Extremity Deep Vein Thrombosis / Q000150:complications / Q000175:diagnosis; D020246:Venous Thrombosis / Q000175:diagnosis / Q000601:surgery*
keywords: Paget-Schröetter; clavicle fracture; pseudarthrosis; thoracic outlet