Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Mar 29;18(1):129.
doi: 10.1186/s12891-017-1488-2.

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

Affiliations

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

Marc Beirer et al. BMC Musculoskelet Disord. .

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.

PubMed Disclaimer

Figures

Fig. 1
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
Fig. 2
Refracture 5 weeks after implant removal (patient No. 9). a before implant removal; b 5 weeks after implant removal
Fig. 3
Fig. 3
Functional outcome. Preoperative relative Constant Score (preoperative); final relative Constant Score (final follow-up); points (pts.)
Fig. 4
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

References

    1. Rhinelander FW. Tibial blood supply in relation to fracture healing. Clin Orthop Relat Res. 1974;105:34–81. - PubMed
    1. Canadian Orthopaedic Trauma S. Nonoperative treatment compared with plate fixation of displaced midshaft clavicular fractures. A multicenter, randomized clinical trial. J Bone Joint Surg Am. 2007;89:1–10. doi: 10.2106/00004623-200701000-00001. - DOI - PubMed
    1. Robinson CM, Court-Brown CM, Mcqueen MM, et al. Estimating the risk of nonunion following nonoperative treatment of a clavicular fracture. J Bone Joint Surg Am. 2004;86-A:1359–65. doi: 10.2106/00004623-200407000-00002. - DOI - PubMed
    1. Moseley HF. The clavicle: its anatomy and function. Clin Orthop Relat Res. 1968;58:17–27. doi: 10.1097/00003086-196805000-00005. - DOI - PubMed
    1. Martetschlager F, Gaskill TR, Millett PJ. Management of clavicle nonunion and malunion. J Shoulder Elbow Surg. 2013;22:862–8. doi: 10.1016/j.jse.2013.01.022. - DOI - PubMed