Background Plate fixation using a tricortical iliac bone graft can provide a high ratio of bone union and restore clavicle length in cases of atrophic nonunion. However, the surgical treatment of clavicle oblique nonunions with marked shortening deformity remains challenging and unresolved. Here, we describe a case of clavicle oblique nonunion with shortening that was treated using plate fixation with parallelogram prism iliac bone grafts. Case presentation A 46-year-old man presented to our hospital with severe medial scapular pain. He had been diagnosed with a right clavicle mid-shaft fracture in a motorcycle accident 9 months earlier. He underwent conservative treatment, but radiographs and computed tomography showed clavicle oblique nonunion with marked shortening. Physical examination revealed no pain at the nonunion site; however, tenderness was noted on the medial side of the right scapula and protrusion of the inferior scapular angle was prominent. His symptoms interfered with daily life and required surgery. After release of the nonunion, we harvested the parallelogram prism bone grafts from the iliac crest. We inserted these bone grafts into the fracture ends and fixed them with lag screws, after which we performed plate fixation. Immediately after surgery, right medial scapular pain and scapula winging subsided. Bone union was achieved, and the length of the clavicle was restored at 9 months postoperatively. Conclusions This case report provides new information on the surgical treatment of clavicle oblique nonunion with shortening deformity. The presence of medial scapular pain and winging scapula can be clinically problematic in cases of clavicle nonunion with marked shortening. Our case revealed that reliable bone union and clavicle length recovery can be achieved with plate fixation and iliac bone grafts.

Background Inferior subluxation of the humeral head is frequently observed immediately after surgery for proximal humerus fractures; however, the incidence and risk factors of inferior subluxation after osteosynthesis for isolated greater tuberosity fractures remain unsolved. Additionally, the postoperative course of inferior subluxation has not been elucidated. The purpose of the present study is to identify the predictors for the occurrence of postoperative inferior subluxation by multivariate analysis and investigate the postoperative shift of inferior subluxation and its effect on surgical outcomes. Methods We retrospectively identified 68 patients who underwent surgery for isolated greater tuberosity fractures. The dependent variable was the inferior subluxation at 1 week postoperatively. The explanatory variables were age, sex, affected side of the shoulder, body mass index, history of smoking, local osteoporosis, time period to surgery, axillary nerve injury, inferior subluxation before surgery, fracture dislocation, surgical approach, surgical method, operative time, amount of blood loss, and postoperative drainage. Baseline variables that were statistically significant in the univariate analyses were included in the logistic regression analysis. The patients were further categorized into two groups according to the presence of inferior shoulder subluxation exhibited 1 week postoperatively: patients with inferior subluxation (+ IS group) and patients without inferior subluxation (− IS group). We compared the incidence of postoperative complications between the two groups. Results Of 68 patients, 17 (25.0%) had inferior shoulder subluxation observed 1 week postoperatively. Multivariate analysis showed that long operative time was a risk factor for postoperative subluxation (odds ratio = 1.03; P = 0.030). In all cases, inferior subluxation disappeared within 3 months of surgery. No significant difference in complication rate was observed between the + IS and − IS groups. Conclusions The present study provides novel information regarding postoperative inferior subluxation of fractures of the greater tuberosity. Inferior subluxation occurred in 25% of patients immediately after surgery. Long operative time contributes to the onset of postoperative inferior subluxation; however, this was temporary in all cases and had no significant effect on the surgical outcomes. Level of Evidence: Level III.

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Background Antegrade intramedullary nail fixation for humeral shaft fractures yields satisfactory union rates. However, one concern is damage to the rotator cuff during nail insertion, which may affect long-term outcomes. The effect of rotator cuff lesion on mid- and long-term shoulder outcomes remains unknown. This study aimed to investigate the incidence of rotator cuff tears 5 years or more after intramedullary nailing for humeral shaft fractures, and to determine the impact of postoperative rotator cuff tears on mid-term outcomes. Methods We retrospectively identified 22 patients who underwent antegrade intramedullary nail fixation for traumatic humeral shaft fractures and received follow-up for at least 5 years postoperatively. We divided the patients into those without tears and those with partial or complete tears, diagnosed using ultrasonography. We compared the functional and radiological shoulder outcomes between the two groups. Results Of 22 patients, nine had partial or complete supraspinatus tears at a mean follow-up of 7.5 years postoperatively. The incidence of acromial spurs was significantly higher in patients with partial or complete tears than in those without tears (P = 0.002). There were no significant differences in age and gender-adjusted Constant score, and American Shoulder and Elbow Surgeon score between the two groups. Conclusions Our results showed that 41% of patients developed partial or complete supraspinatus tendon tears in the mid-term. Postoperative rotator cuff tears were significantly associated with the formation of acromial spurs; however, it had no significant effect on shoulder functional outcomes.