From pitch to palsy: A rare case of acute brachial plexopathy following medial clavicle fracture in women's rugby.

Background: Medial third clavicle fractures represent less than 5% of all clavicle fractures and are rarely associated with acute brachial plexus injury. Early recognition is critical, as timely surgical intervention may influence neurological recovery. Case: A 17-year-old elite rugby player sustained a closed, displaced medial third clavicle fracture following a high-energy tackle, confirmed on radiographs. Within 48 h, she developed profound C5-C6 sensorimotor deficits. CT angiography excluded vascular injury. MRI demonstrated focal T2 hyperintensity and enlargement of the upper trunk consistent with nerve oedema and axonal injury. The posteriorly displaced medial clavicle fragment compressed the brachial plexus, the sharp edges raised concern for a focal injury. A dual-level injury involving traction at the root and focal injury at the trunk could not be excluded. Nerve conduction studies revealed conduction block without axonal disruption. At two weeks, she underwent open reduction, internal fixation, and brachial plexus exploration. The C5-C6 roots were in continuity, and the upper trunk was contused; external neurolysis was performed. Sensory symptoms resolved by week 3; motor recovery began at week 4; complete functional recovery and return-to-play was achieved at 6-month follow-up. Conclusion: Early imaging and decompression are essential to optimise recovery in medial clavicle fractures with acute brachial plexopathy.