Symptomatic Nonunion After Fracture Clavicle, What Is the Functional Outcome After Open Reduction and Internal Fixation With a Curved Reconstruction Plate?

Abstract

Background: Although fracture mid shaft clavicle always united with a good functional outcome, nonunion of fracture clavicle always leads to impaired shoulder joint functions with a significant disability that can cause poor functional outcome and limitations of shoulder joint activities due to pain and stiffness. Materials and Methods: From July 2005 through October 2011, twenty (20) patients (13 males and 7 females) were suffering from symptomatic nonunion of the mid-shaft clavicle (no union for more than three months). They had treated operatively in 14 patients who had suffered from the atrophic nonunion by using a curved reconstruction plate and autologous iliac bone grafting and in six patients with hypertrophic nonunion of mid-shaft clavicle fracture by using a curved reconstruction plate and "local bone grafting" from local callus, bone chips. The American Academy of Orthopedic Surgeons (AAOS) disabilities of the arm, shoulder and hand (DASH) questionnaire was used for the outcome results evaluation. Results: The patients were followed-up for an average of 15 months (range from one year to four years). All fractures were united within three months. The preoperative DASH score was varied from 80 to 70, mean (75). The postoperative DASH score was varied from, 10 to 25, mean (12.7) in our series. Functionally, this was very much acceptable. Conclusion: Based on the results of our and other studies, we recommended open reduction and internal fixation with using a curved reconstruction plate and autologous iliac bone grafting in patients whom suffering from the atrophic nonunion. For treating patients whom suffering from hypertrophic nonunion of mid-shaft clavicle fracture we recommended using a curved reconstruction plate and local bone graft as a sufficient procedure to achieve necessary union, and autologous bone graft from other sites of the body appears to be unnecessary. This successful procedure had a good functional outcome and most of the patients had promising results, as regard to return to a near normal level of function.