Abstract
Clavicle fractures are common injuries. Many non-displaced clavicle fractures are successfully treated non-operatively, while displaced and shortened fractures are often treated with surgery. Fixation methods include plate osteosynthesis as the primary mode and also intramedullary fixation. Several factors contribute to the mechanical burden imparted to the implants used in primary fixation, which may ultimately lead to failed fixation. These include the deforming forces on the clavicle, including the weight of the arm and muscular attachments, and the degree of multiplanar motion the clavicle undergoes with shoulder motion. Historical plate designs were typically thin and malleable lending to fatigue failure; modern plating designs tend to be stronger and are often pre-contoured lending to more fatigue resistance and ease of plate application. Failure of fixation, when it occurs, can be related to any combination of these factors. Bilateral radiographs and computed tomography (CT) scans of the clavicle can aid in the diagnosis of failed fixation and can aid in surgical planning for revision surgery. A thorough pre-operative plan and an inventory of the necessary equipment enable a successful revision surgery. Revision surgery can be performed with various options of plate types, plate locations, plate quantities, bone graft (structural or non-structural), and augmentation with suture and tendon allografts as needed depending on the fracture morphology, fracture location, and biological needs.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Robinson CM. Fractures of the clavicle in the adult. Epidemiology and classification. J Bone Joint Surg Br. 1998;80(3):476–84.
Canadian Orthopaedic Trauma Society. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89(1):1–10.
Smeeing DPJ, van der Ven DJC, Hietbrink F, et al. Surgical versus nonsurgical treatment for midshaft clavicle fractures in patients aged 16 years and older: a systematic review, meta-analysis, and comparison of randomized controlled trials and observational studies. Am J Sports Med. 2017;45(8):1937–45.
Frima H, van Heijl M, Michelitsch C, et al. Clavicle fractures in adults; current concepts. Eur J Trauma Emerg Surg. 2020;46(3):519–29.
Johnson EW, Collins HR. Nonunion of the clavicle. Arch Surg. 1963;87:963–6.
Neer CS 2nd. Nonunion of the clavicle. J Am Med Assoc. 1960;172:1006–11.
Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res. 1968;58:29–42.
Martetschläger F, Gaskill TR, Millett PJ. Management of clavicle nonunion and malunion. J Shoulder Elb Surg. 2013;22(6):862–8.
McKee RC, Whelan DB, Schemitsch EH, McKee MD. Operative versus nonoperative care of displaced midshaft clavicular fractures: a meta-analysis of randomized clinical trials. J Bone Joint Surg Am. 2012;94(8):675–84.
Robinson CM, Goudie EB, Murray IR, et al. Open reduction and plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a multicenter, randomized, controlled trial. J Bone Joint Surg Am. 2013;95(17):1576–84.
Woltz S, Krijnen P, Schipper IB. Plate fixation versus nonoperative treatment for displaced midshaft clavicular fractures: a meta-analysis of randomized controlled trials. J Bone Joint Surg Am. 2017;99(12):1051–7.
Woltz S, Stegeman SA, Krijnen P, et al. Plate fixation compared with nonoperative treatment for displaced midshaft clavicular fractures: a multicenter randomized controlled trial. J Bone Joint Surg Am. 2017;99(2):106–12.
Van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elb Surg. 2012;21(3):423–9.
Lazarides S, Zafiropoulos G. Conservative treatment of fractures at the middle third of the clavicle: the relevance of shortening and clinical outcome. J Shoulder Elb Surg. 2006;15(2):191–4.
Rasmussen JV, Jensen SL, Petersen JB, Falstie-Jensen T, Lausten G, Olsen BS. A retrospective study of the association between shortening of the clavicle after fracture and the clinical outcome in 136 patients. Injury. 2011;42(4):414–7.
Jones GL, McCluskey GM, Curd DT. Nonunion of the fractured clavicle: evaluation, etiology, and treatment. J South Orthop Assoc. 2000;9(1):43–54.
Ropars M, Thomazeau H, Huten D. Clavicle fractures. Orthop Traumatol Surg Res. 2017;103(1S):S53–9.
Bachoura A, Deane AS, Wise JN, Kamineni S. Clavicle morphometry revisited: a 3-dimensional study with relevance to operative fixation. J Shoulder Elb Surg. 2013;22(1):e15–21.
Liu W, Xiao J, Ji F, Xie Y, Hao Y. Intrinsic and extrinsic risk factors for nonunion after nonoperative treatment of midshaft clavicle fractures. Orthop Traumatol Surg Res. 2015;101(2):197–200.
Salipas A, Kimmel LA, Edwards ER, Rakhra S, Moaveni AK. Natural history of medial clavicle fractures. Injury. 2016;47(10):2235–9.
Throckmorton T, Kuhn JE. Fractures of the medial end of the clavicle. J Shoulder Elb Surg. 2007;16(1):49–54.
Robinson CM, Court-Brown CM, McQueen MM, Wakefield AE. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004;86(7):1359–65.
Simpson NS, Jupiter JB. Clavicular nonunion and malunion: evaluation and surgical management. J Am Acad Orthop Surg. 1996;4(1):1–8.
Boehme D, Curtis RJ, DeHaan JT, Kay SP, Young DC, Rockwood CA. Non-union of fractures of the mid-shaft of the clavicle. Treatment with a modified Hagie intramedullary pin and autogenous bone-grafting. J Bone Joint Surg Am. 1991;73(8):1219–26.
Han D, Han N, Xue F, Zhang P. A novel specialized staging system for cancellous fracture healing, distinct from traditional healing pattern of diaphysis corticalfracture? Int J Clin Exp Med. 2015;8(1):1301–4.
Ersen A, Atalar AC, Birisik F, Saglam Y, Demirhan M. Comparison of simple arm sling and figure of eight clavicular bandage for midshaft clavicular fractures: a randomised controlled study. Bone Joint J. 2015;97-B(11):1562–5.
Andersen K, Jensen PO, Lauritzen J. Treatment of clavicular fractures. Figure-of-eight bandage versus a simple sling. Acta Orthop Scand. 1987;58(1):71–4.
Smekal V, Attal R, Dallapozza C, Krappinger D. Elastic stable intramedullary nailing after corrective osteotomy of symptomatic malunited midshaft clavicular fractures. Oper Orthop Traumatol. 2011;23(5):375–84.
Chiu YC, Huang KC, Shih CM, Lee KT, Chen KH, Hsu CE. Comparison of implant failure rates of different plates for midshaft clavicular fractures based on fracture classifications. J Orthop Surg Res. 2019;14(1):220.
Woltz S, Duijff JW, Hoogendoorn JM, et al. Reconstruction plates for midshaft clavicular fractures: a retrospective cohort study. Orthop Traumatol Surg Res. 2016;102(1):25–9.
Shin SJ, Do NH, Jang KY. Risk factors for postoperative complications of displaced clavicular midshaft fractures. J Trauma Acute Care Surg. 2012;72(4):1046–50.
Mirzatolooei F. Comparison between operative and nonoperative treatment methods in the management of comminuted fractures of the clavicle. Acta Orthop Traumatol Turc. 2011;45(1):34–40.
Renfree T, Conrad B, Wright T. Biomechanical comparison of contemporary clavicle fixation devices. J Hand Surg Am. 2010;35(4):639–44.
Little KJ, Riches PE, Fazzi UG. Biomechanical analysis of locked and non-locked plate fixation of the clavicle. Injury. 2012;43(6):921–5.
Wang SH, Lin HJ, Shen HC, Pan RY, Yang JJ. Biomechanical comparison between solid and cannulated intramedullary devices for midshaft clavicle fixation. BMC Musculoskelet Disord. 2019;20(1):178.
Havet E, Duparc F, Tobenas-Dujardin A-C, Muller J-M, Delas B, Fréger P. Vascular anatomical basis of clavicular non-union. Surg Radiol Anat. 2008;30(1):23–8.
Backus JD, Merriman DJ, McAndrew CM, Gardner MJ, Ricci WM. Upright versus supine radiographs of clavicle fractures: does positioning matter? J Orthop Trauma. 2014;28(11):636–41.
Sadiq S, Waseem M, Peravalli B, Doyle J, Dunningham T, Muddu BN. Single or double plating for nonunion of the clavicle. Acta Orthop Belg. 2001;67(4):354–60.
Stufkens SA, Kloen P. Treatment of midshaft clavicular delayed and non-unions with anteroinferior locking compression plating. Arch Orthop Trauma Surg. 2010;130(2):159–64.
Michel PA, Katthagen JC, Heilmann LF, Dyrna F, Schliemann B, Raschke MJ. Biomechanics of upper extremity double plating. Z Orthop Unfall. 2020;158(2):238–44.
Baker JF, Mullett H. Clavicle non-union: autologous bone graft is not a necessary augment to internal fixation. Acta Orthop Belg. 2010;76:725–9.
Khan SA, Shamshery P, Gupta V, Trikha V, Varshney MK, Kumar A. Locking compression plate in long standing clavicular nonunions with poor bone stock. J Trauma. 2008;64(2):439–41.
O’Connor D, Kutty S, McCabe JP. Long-term functional outcome assessment of plate fixation and autogenous bone grafting for clavicular non-union. Injury. 2004;35(6):575–9.
Olsen BS, Vaesel MT, Søjbjerg JO. Treatment of midshaft clavicular nonunion with plate fixation and autologous bone grafting. J Shoulder Elb Surg. 1995;4(5):337–44.
Zhang J, Yin P, Han B, Zhao J, Yin B. The treatment of the atrophic clavicular nonunion by double-plate fixation with autogenous cancellous bone graft: a prospective study. J Orthop Surg Res. 2021;16(1):22.
Jones AL, Bucholz RW, Bosse MJ, et al. Recombinant human BMP-2 and allograft compared with autogenous bone graft for reconstruction of diaphyseal tibial fractures with cortical defects. A randomized, controlled trial. J Bone Joint Surg Am. 2006;88(7):1431–41.
Arrington ED, Smith WJ, Chambers HG, Bucknell AL, Davino NA. Complications of iliac crest bone graft harvesting. Clin Orthop Relat Res. 1996;329:300–9.
Robertson PA, Wray AC. Natural history of posterior iliac crest bone graft donation for spinal surgery: a prospective analysis of morbidity. Spine (Phila Pa 1976). 2001;26(13):1473–6.
Sasso RC, LeHuec JC, Shaffrey C, Spine Interbody Research Group. Iliac crest bone graft donor site pain after anterior lumbar interbody fusion: a prospective patient satisfaction outcome assessment. J Spinal Disord Tech. 2005;18(Suppl):S77–81.
Lenoir H, Williams T, Kerfant N, Robert M, Le Nen D. Free vascularized fibular graft as a salvage procedure for large clavicular defect: a two cases report. Orthop Traumatol Surg Res. 2013;99(7):859–63.
Riggenbach MD, Jones GL, Bishop JY. Open reduction and internal fixation of clavicular nonunions with allograft bone substitute. Int J Shoulder Surg. 2011;5(3):61–7.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2024 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Page, B.J., Ricci, W.M. (2024). Failed Fixation of Clavicle Fracture. In: Giannoudis, P.V., Tornetta III, P. (eds) Failed Fracture Fixation. Springer, Cham. https://doi.org/10.1007/978-3-031-39692-2_5
Download citation
DOI: https://doi.org/10.1007/978-3-031-39692-2_5
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-39691-5
Online ISBN: 978-3-031-39692-2
eBook Packages: MedicineMedicine (R0)