Blunt subclavian artery trauma following clavicle fracture is rare. Some controversy exists in the literature regarding the sequence of surgery. We report a case where vascular repair preceded clavicular fixation with excellent outcome. We positioned the graft far away from the fracture site and therefore subsequent manipulation to reduce the fracture was safer. The final decision should be a team one, made by the vascular surgeon, the orthopaedic surgeon and the anaesthetist. Case Report A 23-year-old right-handed woman attended the emergency department after being thrown from her horse. Examination revealed a large haematoma over the right clavicle and absent right brachial and radial pulses. Neurological examination was normal. Early vascular input was sought.Radiographs confirmed a displaced fracture of the right clavicle at the junction of the medial 2/3 and distal 1/3 (Figure 1). There were no other injuries. Duplex studies were performed in the emergency department and confirmed absent radial pulse with no Doppler signal. Formal angiography showed occlusion of the proximal subclavian artery just beyond the origin of the right internal mammary and vertebral arteries. The occlusion measured ~ 5 to 6 cm with sluggish reconstitution of the right axillary artery distally. Radiological stenting was attempted and failed.
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