Rupture of subclavian artery pseudoaneurysm after clavicle nonunion surgery in adolescents: a case report

Abstract Background Adolescent clavicle fractures usually have a satisfactory prognosis after conservative treatment and an extremely low incidence of nonunion. This article reports a rare case: a clavicle nonunion and congenital absence in most of the first-rib patients. He was found to have a ruptured subclavian artery pseudoaneurysm after clavicle nonunion surgery. Case presentation A 15-year-old boy sustained a right clavicle fracture three years ago, which, left untreated, gradually progressed to clavicle nonunion. The patient came to our hospital for surgical treatment. The admission X-ray revealed mid-clavicle nonunion and congenital absence of most of the first rib. We performed open reduction and internal fixation of the clavicle nonunion after a thorough examination. A rupture of the subclavian artery pseudoaneurysm was found 2 days after surgery, and the patient was sent to emergency intervention for embolization of the subclavian artery pseudoaneurysm. The hematoma compression caused a brachial plexus nerve injury. The patient gradually recovered after rehabilitation. Conclusions Congenital rib deformity in adolescents may be combined with peripheral vascular and nerve variations, and long-term compression of the subclavian artery by clavicle nonunion can aggravate vascular malformation. Such patients should prevent vascular rupture during surgery.