Mid-term outcome following revision surgery of clavicular non- and malunion using anatomic locking compression plate and iliac crest bone graft

Abstract

Background: Treatment of clavicular non- and malunion is still challenging. Current surgical procedures often result in frustrating functional outcome along with high-grade subjective impairment and increased rates of revision surgery. However, the combination of biological augmentation with vital bone graft and a biomechanically sufficient fixation system seems to be a promising concept of treatment.

Methods: In this retrospective study, 14 patients with a mean age of 44 years (26-67 years) suffering from non-union (n = 11) and/or malunion (n = 3) of the clavicle were enrolled. All patients were surgically treated using an anatomical precontoured locking compression plate (LCP) and autologous iliac crest bone graft. Functional outcome was assessed using the age- and sex-specific relative Constant Score.

Results: Mean follow-up was 27 months (range 12-44 months). The relative Constant Score significantly improved from preoperative 61 ± 8 (43-72) to 82 ± 10 (65-100) points at the final follow-up examination (p < 0.05). All patients showed bony union radiographically. One patient presented with a re-fracture of the clavicle nearly 3 years after revision surgery and 5 weeks after implant removal. Secondary fractures at the donor site of the anterior superior iliac spine were recorded in two patients.

Conclusions: Iliac crest bone graft and anatomic locking plate fixation allow for a safe and adequate stabilization and radiographical bony union in non- and malunions of the clavicle with a high degree of patient satisfaction. However, secondary fractures of the anterior superior iliac spine constitute relevant complications and the time of hardware removal should be considered carefully.

Keywords: Clavicle; Complication; Iliac crest bone graft; Locking compression plate; Malunion; Non-union.

Fig. 1

Radiographical outcome of a clavicular non-union (patient No. 10). a preoperative; b postoperative; c 2-year follow-up; d after plate removal

Fig. 2

Refracture 5 weeks after implant removal (patient No. 9). a before implant removal; b 5 weeks after implant removal

Fig. 3

Functional outcome. Preoperative relative Constant Score (preoperative); final relative Constant Score (final follow-up); points (pts.)

Fig. 4

Radiological outcome of a non-union after non-locking plate fixation with only two screws lateral to the fracture gap (patient No. 6). a preoperative; b postoperative; c 1-year follow-up; d 2-year follow-up