Clavicle Malunions: Surgical Treatment and Outcome—a Literature Review

Sidler-Maier, Claudia C.; Dedy, Nicolas J.; Schemitsch, Emil H.; McKee, Michael D.

doi:10.1007/s11420-017-9583-3

Cited by 11 publications

(15 citation statements)

References 33 publications

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“…Historically, symptomatic malunion has represented the other concerning complication of nonoperative treatment of clavicle fractures. In addition to several studies of adults, 17,32 1 retrospective series described 4 of 15 adolescent patients with completely displaced fractures who were initially treated nonoperatively but later underwent osteotomy and plate fixation for symptomatic malunions. No functional outcome measures were obtained in either treatment group, and no statistical comparison was made with the operative group, 16% of whom underwent secondary surgery for hardware removal.…”

Section: Discussionmentioning

confidence: 99%

Two-Year Functional Outcomes of Operative vs Nonoperative Treatment of Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results From the Prospective Multicenter FACTS Study Group

et al. 2022

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Background: The optimal treatment of midshaft clavicle fractures is controversial. Few previous comparative functional outcome studies have investigated these fractures in adolescents, the most commonly affected epidemiologic subpopulation. Purpose/Hypothesis: The purpose was to prospectively compare the outcomes of operative versus nonoperative treatment in adolescents with completely displaced midshaft clavicle fractures. The study hypothesis was that surgery would yield superior outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: Patients aged 10 to 18 years treated for a midshaft clavicle fracture over a 5-year period at 1 of 8 pediatric centers were prospectively screened, with independent treatment decisions determined by individual musculoskeletal professionals. Demographics, radiographic clinical features, complications, and patient-reported outcomes (PROs) were prospectively recorded for 2 years. Regression and matching techniques were utilized to adjust for potential age- and fracture severity–based confounders for creation of comparable subgroups for analysis. Results: Of 416 adolescents with completely displaced midshaft clavicle fractures, 282 (68) provided 2-year PRO data. Operative patients (n = 88; 31%) demonstrated no difference in sex (78% male) or athletic participation but were older (mean age, 15.2 vs 13.5 years; P < .001), had more comminuted fractures (49.4% vs 26.3%; P < .001), and had greater fracture shortening (25.5 vs 20.7 mm; P < .001) than nonoperative patients (n = 194; 69%). There was no difference in mean PRO scores or rates of “suboptimal” scores (based on threshold values established a priori) between the operative and nonoperative treatment groups (American Shoulder and Elbow Surgeons, 96.8 vs 98.4; shortened version of the Disabilities of the Arm, Shoulder and Hand, 3.0 vs 1.6; EuroQol [EQ] visual analog scale, 93.0 vs 93.9; EQ–5 Dimensions index, 0.96 vs 0.98), even after regression and matching techniques adjusted for confounders. Operative patients had more unexpected subsequent surgery (10.4% vs 1.4%; P = .004) and clinically significant complications (20.8% vs 5.2%; P = .001). Overall, nonunion (0.4%), delayed union (1.9%), symptomatic malunion (0.4%), and refracture (2.6%) were exceedingly rare, with no difference between treatment groups. Conclusion: Surgery demonstrated no benefit in patient-reported quality of life, satisfaction, shoulder-specific function, or prevention of complications after completely displaced clavicle shaft fractures in adolescents at 2 years after injury. Registration: NCT04250415 ( ClinicalTrials.gov identifier).

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Section: Discussionmentioning

confidence: 99%

Two-Year Functional Outcomes of Operative vs Nonoperative Treatment of Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results From the Prospective Multicenter FACTS Study Group

et al. 2022

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“…Corrective osteotomy, bone grafting, and plate fixation have led to good clinical outcomes with high patient satisfaction in adult populations. [75][76][77] In a group of 16 adolescents who underwent surgery for failed nonoperative treatment, including cases of nonunion, delayed union, and malunion, it was demonstrated that plate fixation with or without osteotomy for a symptomatic bony bump led to comparable time to union and complication rates as primary surgical fixation. 78 Given a high activity level and an emphasis on rapid return to sports, refracture is also a complication of interest in adolescents.…”

Section: Complicationsmentioning

confidence: 99%

Evaluation and Management of Midshaft Clavicle Fractures in Adolescents

Jasty

Heyworth²

2020

Journal of the Pediatric Orthopaedic Society of North America

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The rate of operative fixation for completely displaced mid-shaft clavicle fractures in adolescents has been increasing yearly over the last decade, largely driven by studies of adult populations, in whom the rate of nonunion is approximately 15% with non-operative treatment. However, nonunion and symptomatic malunion in younger populations remain rare. Recent studies suggest that functional outcomes are similar between conservative management and operative fixation in adolescents, with higher rates of complications and slightly decreased time to return to sport with operative fixation. Implant-related symptoms after surgery remains an important consideration, due to potential for reoperation for implant removal. Additionally, the cost of operative fixation is significantly higher than that of non-operative management. The aim of this review is to summarize the salient historical and more recent literature regarding displaced mid-shaft clavicle fractures in order to better understand treatment considerations and the natural history of these fractures in the adolescent.

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“…1,2,5,7,10,30,31 Several authors have described successful surgical techniques to treat these symptomatic malunions, but none have shown superiority. 28 This technique has been applied in five patients and early results look promising with on average over 20 points decrease of DASH score. The surgical technique as described as above is an altered version of the sliding osteotomy technique described by McKee et al 12 It is a relatively simple technique which requires plane X-rays, no additional equipment or scans.…”

Section: Discussionmentioning

confidence: 95%

“…All of the abovementioned techniques have been reported successful, but none have shown superiority. 28 We have developed a technique based on the sliding osteotomy with excising a wedge for more anatomic correction of clavicle malunion without the necessity of CT and 3D reconstructions or difficult multi-plane osteotomy. Early results look promising.…”

Section: Introductionmentioning

confidence: 99%

A simple surgical technique for correcting malunion after midshaft clavicle fracture

Essen¹,

Hillen²

2020

Shoulder & Elbow

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Clavicle malunion occurs in two-thirds of all clavicle fractures treated conservatively. It can lead to pain, shoulder dysfunction and cosmetic complaints. Surgical treatment of all midshaft fractures will lead to overtreatment, as not all malunions are symptomatic. In the past, several treatment modalities for correcting malunion of the clavicle have been described, and all have been successful but none have shown superiority. This article describes a new surgical technique with excising a wedge to realign the clavicle malunion.

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Clavicle Malunions: Surgical Treatment and Outcome—a Literature Review

Cited by 11 publications

References 33 publications

Two-Year Functional Outcomes of Operative vs Nonoperative Treatment of Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results From the Prospective Multicenter FACTS Study Group

Two-Year Functional Outcomes of Operative vs Nonoperative Treatment of Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results From the Prospective Multicenter FACTS Study Group

Evaluation and Management of Midshaft Clavicle Fractures in Adolescents

A simple surgical technique for correcting malunion after midshaft clavicle fracture

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