Double clavicular fractures associated with scapular neck and coracoid process fractures

We report a 38-year-old man with a combination of fractures in his left shoulder involving the middle and distal clavicle, the scapular neck, and the coracoid process, associated with scapulothoracic dissociation and an upper brachial plexus injury. The middle clavicular fracture was fixed with a plate, whereas the distal clavicular fracture was fixed with tension band wiring. Internal fixation for fractures of the scapular neck and coracoid process was not performed, as they were in an acceptable position after fixation of the clavicular fractures. At the 14-month follow-up, the range of motion of the left elbow, the wrist, and all fingers had recovered fully, whereas that of the left shoulder was limited to 35º abduction, 20º flexion, and 20º external rotation. The strength of the left shoulder abduction, flexion, and external rotation was M2. Elbow flexion, wrist extension, and finger extension strength had recovered to normal (M5). Sensation corresponding to the C5-6 dermatome had also improved to almost normal.