Elsevier

Journal of Shoulder and Elbow Surgery

Volume 17, Issue 6, November–December 2008, Pages 951-953
Journal of Shoulder and Elbow Surgery

Original Article
Nonunion of the clavicle treated with plate fixation: A review of forty-seven consecutive cases

https://doi.org/10.1016/j.jse.2008.05.046Get rights and content

Forty-seven consecutive patients underwent superior plating for clavicular nonunion between 1995 and 2005. This retrospective analysis was performed to assess the efficacy of plate fixation and the need for iliac crest bone grafting. Forty-three patients were treated with pelvic reconstruction plates and four with straight dynamic compression plates. Of the patients, 30 were treated with local bone graft only, 14 with demineralized bone matrix, and 3 with distant autogenous bone graft. Of the fractures, 93% united after a single operation. Of the patients, 69% returned the Disabilities of the Arm, Shoulder and Hand questionnaire. The mean Disabilities of the Arm, Shoulder and Hand score was 14.6 (range, 0-53). Plate prominence or sensitivity resulted in removal in 20% of cases. We believe that superiorly applied plate fixation is effective for the treatment of clavicular nonunion. Distant autogenous bone graft is not necessary in most cases to obtain union.

Section snippets

Materials and methods

Our fracture database was used to identify all patients treated for clavicular nonunion from 1995 to 2005. Forty-seven patients were identified with symptomatic, painful nonunions treated with ORIF via a plate applied superiorly. Of these patients, 1 was lost to follow-up and 1 died, leaving 45 patients with sufficient follow-up to assess union. There were 14 female patients and 33 male patients, with a mean age of 38.7 years (range, 12-68 years). Of the patients, 23 sustained left clavicle

Results

Of 45 patients, 42 (93%) progressed to union. A second surgery was required in 3 patients (7%) because of implant loosening. Two of these were treated initially with a dynamic compression plate and another with a pelvic reconstruction plate. None had a fracture pattern that allowed for interfragmentary compression screws. Two of the three were smokers. Revision surgery was done with a curved reconstruction plate in each case, and all went on to achieve union. There were no intraoperative

Discussion

Nonunion is a relatively common complication after clavicle fracture. Recent studies suggest a higher incidence than previously thought. Various methods have been used to deal with this sometimes difficult problem. This series suggests that plate fixation on the superior surface of the clavicle is a reliable and predictable method of repair.

Some problems with plate fixation have been identified. Plate application requires a broad exposure, placing the supraclavicular sensory nerves at risk. Of

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This work was supported by a grant from Synthes USA.

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