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LETTERS TO THE EDITOR

A Fractured Clavicle and Vascular Compression: A Non-Orthopedic Indication of Figure–of–Eight Bandage

Departments of Anaesthesia and Intensive Care and Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India

To the Editor:

A fractured clavicle has various vascular implications (1,2). We observed vascular compression in two cases of a fractured clavicle during non-clavicular surgery. Both cases had right fractured clavicles and required right lateral positioning, intraoperatively. Incidentally, in both cases, the peripheral vein was secured on the right arm, i.e. ipsilateral arm of the fractured side. As soon as the right lateral position was attained, IV drip stopped running with a back-flow of blood. Neither flushing the line, inserting needle-airway nor limb repositioning helped. A subclavian vein occlusion by displaced distal segment of a fractured clavicle was suspected. Turning the patient back to the supine position resulted in normal IV flow in both cases. A figure-of-eight bandage was applied to align fractured segments and the lateral position was resumed. Thereafter, no occlusion to the venous flow was observed. Since the current trend is to use a simple shoulder sling (3) rather than a figure-of-eight bandage (4), intraoperative vascular occlusion by a fractured clavicle may go unnoticed if the ipsilateral arm of the fractured side is not used either for intravenous infusion or for monitoring color, temperature and pulse volume. In conclusion, we should avoid the lateral position in patients with a fractured clavicle side dependent. If unavoidable, monitoring for vascular compression of the dependent arm is mandatory as there could be more serious complications than a blocked intravenous line. A figure-of-eight-bandage before lateral positioning may prevent these complications.

References

1. Craig EV. Fractures of the clavicle. In: Rockwood CA, Matsen FA, Wirth MA, Harryman DT, eds. Rockwood and Matsen, The Shoulder, 2nd ed. WB Saunders, Philadelphia 1998: 428–482.
2. Dash UN, Handler D. A case of compression of subclavian vessels by a fractured clavicle treated by excision of first rib. J Bone Joint Surg 1960; 42A: 798–801.[Abstract/Free Full Text]
3. Voigt C, Enes-Gaiao F, Fahimi S. Treatment of acromioclavicular joint dislocation with the Rah Manzadeh joint plate. Aktuelle Traumatol 1994; 24: 128–132.[Medline]
4. Anderson K, Jensen P, Lauritzen J. Treatment of clavicular fractures: Figure-of-eight bandage vs a simple sling. Acta Orthop Scand 1987; 57: 71–74.

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