鎖骨骨折に鋼線刺入固定術を行って腕神経叢麻痺を来した1例

Brachial Plexus Palsy Caused by Compression by the Distal Fragment after Pin Fixation of a Clavicle Shaft Fracture : Case Report

　抄録：症例は60歳の女性で，前医で鎖骨骨折に対して鋼線刺入固定術を施行された．術翌日から左上肢の疼痛と筋力低下が出現した．鎖骨中1/3の骨折で，短縮転位と鋼線による角状変形が著明であった．骨片が腕神経叢を圧迫して麻痺が発生したと考えて抜釘および内固定術を行った．術後麻痺は速やかに回復した．鎖骨骨折の骨折部位を過去の症例および文献的に調査した．その結果，本例のような腕神経叢直上での骨折は2.5％であった．本例は稀な骨折部位，鋼線固定により生じた骨折部の短縮転位と角状変形という特殊な条件が重なって麻痺が生じた症例と考えた．この部位の骨折に対しては直下の腕神経叢に注意して治療法を選択する必要がある．

　We report a rare case of brachial plexus palsy due to compression by the distal fragment after pin fixation of a clavicle shaft fracture. The patient was a 60-year-old female who had undergone pin fixation for a left clavicle fracture. The day after the operation, she noted pain and weakness in her left arm. Radiography showed shortening and angular deformity of the middle segment of the clavicle shaft. Based on a preoperative diagnosis of compression of the brachial plexus by the distal fragment of the clavicle shaft, we removed the pin and performed open reduction, internal fixation, and bone grafting. After the operation, the pain resolved and the strength of the arm was restored. As far as we have been able to determine, clavicle fracture sites just above the brachial plexus, as in our case, are very rare (2.5％). In our patient the plexus was attributable to the combination of a rare fracture site and shortening and angular deformity of the clavicle shaft after pin fixation. The brachial plexus must therefore be taken into account when choosing appropriate treatment for fractures at this site.