Plating and cortical bone grafting of clavicular nonunions: clinical outcome and its relation to clavicular length restoration

Abstract

Background The goal of this study was to evaluate whether plating and cortical bone grafting of shortened clavicular nonunions would restore clavicular length and enable bone healing. The association between the clavicular length difference (CLD) between sides and long-term functional outcome was also explored. Methods For this retrospective 2-center study, patients who underwent plate fixation with cortical bone grafting of a clavicular nonunion were assessed after ≥2 years. The CLD and bone union were assessed using radiography and navigation ultrasound. The functional outcome was determined by the Constant score, Simple Shoulder Test score, and Subjective Shoulder Value, as well as local pain (0-10 numeric rating scale). Results Between 2 and 13 years after surgery, 25 patients (mean age, 53 years; 13 female patients) were examined. The median CLD was 0 mm (range, –17 to 13 mm) on ultrasound measurements and 2 mm (range, –32 to 9 mm) on radiographs. At follow-up, the median Constant score, Simple Shoulder Test score, Subjective Shoulder Value, and pain level were 82 points (range, 38-95 points), 12 points (range, 3-12 points), 95% (range, 60%-100%), and 0 (range, 0-8), respectively. There was no correlation between the CLD and all functional outcome scores. Bone union was achieved in all patients. After plate removal, 4 refractures occurred, 3 of which required revision. Conclusions Plate fixation with cortical bone grafting of clavicular nonunions is associated with restoration of clavicular length and a high rate of bone union. There is, however, a considerable risk of refracture following plate removal. There was no association between the CLD and clinical outcome.

Plate fixation of midshaft clavicle fractures for delayed union and non-union is a cost-effective intervention but functional deficits persist at long-term follow-up

“…Restoration of clavicle length is not thought to influence clinical outcome of non-union surgery. 29 Muscle wasting, loss of proprioception and joint stiffness would presumably recover with time but subtle muscle fatigue as found in Potter et al.’s series may still exist. 15 Given the prolonged period of discomfort prior to fixation, mental health and treatment dissatisfaction may influence the ultimate recovery as found in other upper limb surgeries.…”

Complications and Outcomes After Surgical Intervention in Clavicular Nonunion

“…In the subanalysis of single-plate (n = 853) 6,11-42 vs. intramedullary (n = 93) 40,43-47 fixation, 39 studies were included (Table V). Of the 14 studies not included, 5 studies reported aggregate outcomes from single and double plating, 5 from multiple fixations methods, 3 from external fixators, and 1 from tension band wiring.…”

“…In the subanalysis of the use of bone graft (n = 687) 6,12,13,15,16,19,22-25,30,32-42,44-52 vs. no bone graft (n = 224) 11,17,23,26,27,29,43,53-55 , 41 studies were included (Table VI). The bone graft subjects had significantly longer follow-up than the nonbone graft group (3 vs. 2 years, p < 0.0001), but there was no difference in age (42 vs. 43 years).…”

Safe and Effective Treatment of Compromised Clavicle Fracture of the Medial and Lateral Third Using Focused Shockwaves

“…In approximately two-thirds of patients with clavicle non-union, surgery is performed due to persistent symptoms [ 59 ]. In addition, surgical treatment of clavicular fracture non-union has achieved excellent healing results, depending on the reported literature [ 31 , 32 , 33 , 36 ]. Our study achieved a healing rate of 71% in the surgical intervention group.…”

“…Consequently, symptomatic pseudarthrosis is primarily surgically treated. Convincing healing results can be achieved by applying different plate configurations and plate localizations, usually combined with bone grafts [ 31 , 32 , 33 , 34 ]. However, a decisive disadvantage is the invasive nature of the intervention in clavicle non-union revision surgery, which is associated with all common complications of surgery.…”