Subclavian Vein Thrombosis following Acute Internal Fixation of a Clavicular Fracture

Abstract

With the recent increase in popularity of early operative fixation for certain clavicular fracture configurations, it is important for orthopaedic surgeons to be mindful of the possible additional risk of thromboembolic complications that may arise as a consequence of an acute injury. We describe the case of a 41-year-old man who presented to our department with a left-sided, middle-third, displaced clavicular fracture. He underwent an acute open reduction and internal fixation, which was complicated by a postoperative subclavian vein thrombosis. This was treated with oral anticoagulation. The thrombus had completely resorbed by 3 months. Five months after surgery, the patient had a full range of movement of the left arm, with no swelling, after having completed a 4000-mile cycle ride. A review of the available literature suggests that the commonest and safest treatment for a subclavian vein thrombosis is subcutaneous unfractionated heparin followed by oral warfarin therapy. The present case report highlights the potential risk of upper limb thrombosis after acute osteo-synthesis of the clavicle and discusses the current evidence with respect to the treatment of upper limb venous thrombosis.