53-year-old male, veteran road cyclist, with no medical or surgical history of interest, toxic habits or known allergic reaction to medication, who consulted our emergency department for fracture of the middle third of the right clavicle and fracture of the right costal arches caused in an accident with a fall on the road.
On admission he was in good general condition, haemodynamically stable, without dyspnoea, suffering from pain in the right clavicle and costal wall with no symptoms or signs of neurovascular involvement of the right upper limb. The simple radiological study showed fracture of the fourth and fifth right costal arches without evidence of haemothorax or pneumothorax, and fracture of the middle third of the right clavicle with third fragment, confirmed by computerised axial tomography (a, 1b).

The patient was initially treated with analgesia, non-steroidal anti-inflammatory drugs and a bandage of eight. Three days later, the patient consulted the same department for swelling of the right upper limb with no loss of sensation and with preserved peripheral pulses, normal vital signs and cardiorespiratory auscultation with normal heart sounds at normal frequency without murmurs or extratonos, and preserved vesicular murmur in both lung fields, without rales or other pathological findings.
Spirometry, electrocardiogram and echocardiogram were normal; blood tests showed abnormal values of MCHC=31.4g/dl, neutrophils=76.6%, lymphocytes=16.4%, eosinophils=0.9%, fibrinogen=645mg/dl, GGT=52U/l and positive D-Dimer. Venous echo-Doppler study revealed venous thrombosis of the axillary, cephalic and basilic veins with compression of the ulnar branch of the medial brachial cutaneous nerve at the level of the basilic hiatus (a, 2b).

The bandage in eight was replaced by a simple sling, which was maintained until the start of functional rehabilitation, and treatment with Tinzapain sodium was carried out, with radiographs and serial Doppler utrasonography for control until the clavicle fracture was consolidated and the thrombosed veins were completely recanalised.
