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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Brachial plexus compression caused by recurrent clavicular non-union and space occupying pseudarthrosis: Definitive reconstruction using free vascularized bone flaps– Series of 8 cases

Meeting Abstract

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  • K. Krishnan - Klinik für Neurochirurgie, Universitätsklinikum Frankfurt
  • D. Martin - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Dresden
  • G. Schackert - Klinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus, Dresden

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocP15-05

DOI: 10.3205/09dgnc415, URN: urn:nbn:de:0183-09dgnc4159

Published: May 20, 2009

© 2009 Krishnan et al.
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Outline

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Objective: Symptomatic brachial plexus compression caused by space-occupying pseudarthrotic clavicular non-union is relatively rare. Both clavicular pseudarthrosis and its surgical treatment have been extensively reported in the literature. However, to our knowledge there is no report on the use of a free vascularized bone flap for the reconstruction of recurrent pseudarthrosis of the clavicle.

Methods: Between August 2001 and March 2005 six male (age: 46-59y) and two female patients (48 and 52y) with complicated mid-shaft clavicle fractures were admitted due to progressive compression of the subclavicular neurovascular bundle. All of them had dislocated traumatic clavicle fractures that were previously treated in other institutions. At least two surgical reconstructive procedures had been performed on the patients beforehand. Clinically, two patients had motor deficits owing to compressive brachial plexus lesions, and all showed symptoms of combined thoracic outlet syndrome (BP compression at rest and under provocation). Our surgery consisted of resection of the space occupying clavicular pseudarthrosis (all patients), external neurolysis of the brachial plexus (4 patients) and reconstruction of the resulting bone defect with a free vascularized fibula flap secured with plates (all patients). Vascularity of the bone flap was studied using three-phase bone scintigraphy.

Results: All patients were relieved of pain symptoms immediately after surgery. Muscle strength improved to normal within three months in two cases. One patient showed an osteo-subcutaneous fistula 6 months after surgery, which was treated conservatively. No other complications were observed. There was no recurrence of pseudarthrosis or neurovascular compression. Bone healing was uneventful; in two patients the plates were removed.

Conclusions: Recurrent space-occupying pseudarthrosis of the clavicle complicated by neurovascular compression warrants reconstruction using a vascularized bone flap, since vascularized tissue offers better healing.