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In this case report, we describe a rare clinical situation of acute arterial thoracic outlet syndrome (TOS) after osteosynthesis, using an intramedullary Knowles pin, to treat nonunion of a midshaft clavicular fracture. Existing evidence was reviewed to appraise the relationship between TOS and nonunion of clavicular fractures, including the timing of the development of this complication, as well as to identify the relationship between surgical technique and choice of implant and the occurrence of TOS. Perioperative measures used to prevent TOS were identified.