Risk profile of patients developing nonunion of the clavicle and outcome of treatment--analysis of fifty five nonunions in seven hundred and twenty nine consecutive fractures

Abstract

Purpose: The most common complication following treatment of a clavicle fracture is nonunion. Most nonunions are symptomatic and treatment is mostly operative. The aim of this study was to describe risk profiles of patients developing nonunion and what outcome is observed following operative treatment of clavicle nonunions.

Methods: In a consecutive series of 729 clavicle fractures we retrospectively identified 55 that developed nonunion (49 diaphysial and six lateral). All were treated operatively by reconstruction with (n = 28) or without (n = 27) autologous bone graft. Assessment of functionality and patient reported satisfaction and remission of symptoms was done a minimum of six months post-operatively by mail. Response rate was 60%.

Results: The overall nonunion rate was 7.5%. Nine nonunions were initially treated operatively. Risk factors associated with nonunion of our series was anatomic site, fracture complexity, female gender, smoking habits and initial treatment. A total of eight post-operative complications were found. Remission of symptoms was reported by 29 of the 33. Outright satisfaction with current shoulder condition was reported by 24. The overall median DASH was 8 (range 0-61). Following revision of the eight complications a total of 53 united successfully.

Conclusion: Operative treatment of a clavicular nonunion seems to be effective as most patients unite and experience remission of symptoms. However, complications in close to 15% and lack of satisfaction of approximately 27% have to be acknowledged and thoroughly explained to the patient prior to treatment.

Keywords: Bone graft; Clavicle fracture; Nonunion; Reconstruction.