Large segmental defects in midshaft clavicle nonunion treated with autologous tricortical iliac crest bone graft

Abstract

Background To evaluate the use of intercalary iliac crest bone graft in the treatment of clavicle nonunion with a large segmental bone defect (3–6 cm). Methods This retrospective study evaluated patients with large segmental bone defects (3–6 cm) after clavicle nonunion, treated with open reposition internal fixation and iliac crest bone graft between February 2003 and March 2021. At follow-up the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was administered. A literature search was performed to provide an overview of commonly used graft types per defect size. Results We included five patients treated with open reposition internal fixation and iliac crest bone graft for clavicle nonunion with a median defect size of 3.3 cm (range 3–6 cm). Union was achieved in all five, and all pre-operative symptoms resolved. The median DASH score was 23 out of 100 (IQR 8-24). An extensive literature search revealed that there are no studies describing the use of an used iliac crest graft for defects larger than 3 cm. Instead, a vascularized graft was typically used to treat defects sizes between 2.5 and 8 cm. Discussion An autologous non-vascularized iliac crest bone graft can be safely used and is reproducible to treat a midshaft clavicle non-union with a bone defect between 3 and 6 cm.

Treatment and Outcome of Fracture-Related Infection of the Clavicle

“…Several studies have focused on the reconstruction of segmental osseous defects using ICBG or FVFG after non-union of the clavicle [11,[33][34][35][36][37][38][39][40]. Most of these were case reports or case series [33][34][35][36][37][38][39][40] and only one of the studies had FRI as their main focus area [11].…”

“…Several studies have focused on the reconstruction of segmental osseous defects using ICBG or FVFG after non-union of the clavicle [11,[33][34][35][36][37][38][39][40]. Most of these were case reports or case series [33][34][35][36][37][38][39][40] and only one of the studies had FRI as their main focus area [11]. The use of ICBG showed a good outcome with union rates ranging from 75% to 100%, with a significant improvement in shoulder function and pain reduction after surgery [35][36][37][38][39].…”

“…Most of these were case reports or case series [33][34][35][36][37][38][39][40] and only one of the studies had FRI as their main focus area [11]. The use of ICBG showed a good outcome with union rates ranging from 75% to 100%, with a significant improvement in shoulder function and pain reduction after surgery [35][36][37][38][39]. Four case reports describing the use of FVFG in nine patients demonstrated good results, with fracture union in eight out of the nine patients, with osseous defect sizes ranging from four centimeters up to twelve centimeters [11,33,34,40].…”

Intercalary Tricortical Iliac Crest Graft for Treatment of Midclavicle Nonunion With Bone Loss: Two Case Reports and Review of Literature

“…However, when initial attempts at treatment of nonunion fail and are associated with significant bone loss, there is much less literature available [7][8][9]. A single recent study was identified that focused on tricortical iliac crest grafts for clavicle fracture nonunion, with a sample size of only five cases, that demonstrated the successful use of tricortical iliac crest grafts in large clavicle nonunion defects rather than vascularized grafts from other locations [10]. To add to this very small dataset, we present two cases of clavicle fractures that failed both initial osteosynthesis and an attempted revision procedure.…”