Anteroinferior Plating of Midshaft Clavicular Nonunions

Abstract

Many different techniques have been reported for the treatment of clavicular nonunions. Those techniques involving screws and plate generally position the plate on the superior (subcutaneous) surface of the clavicle. To decrease the risk of screw pull-out and prominence of the instrumentation, we currently perform anteroinferior plating using a 3.5-millimeter pelvic reconstruction plate with a lag screw and bone graft. A consecutive group of twelve patients with midshaft clavicular nonunions was treated with this technique. All nonunions united after an average of 3.6 months (range 2 to 8 months). All patients regained full function and mobility of the shoulder. The technique as described in this article illustrates a successful modification of the traditional plating technique of midshaft clavicular nonunions. We conclude that anteroinferior plating is a reliable and safe technique that leads to high rates of bony union in midshaft clavicular nonunions.

Anteroinferior Plating of Midshaft Clavicle Nonunions and Fractures

“…We previously reported our experience with this technique using the 3.5-mm pelvic reconstruction plates in 17 patients [4,5] (see Figures 12a and 12b as a representative case). Since then, we have also been using the 3.5-mm LCP pelvic reconstruction plate, and the one-third tubular tubular LCP.…”

“…Arguments for this position are ease of application, and the fact that the superior side of the clavicle reflects the tension side. We have introduced anteroinferior plating based on an original idea of Jeffrey Mast (personal communication) [4,5]. Benefits of anteroinferior plating are its relatively nonobtrusive presence, longer screw purchase as the superior-inferior diameter is shorter than the anteroinferiorposterosuperior diameter, and decreased risk of neurovascular injury by drill and/or screws.…”

“…Nonunions of the midshaft clavicle cause disabling discomfort and deformity [2,4,5,8]. Patients complain of pain, decreased shoulder motion and brachialgia which comes as a complex of neurovascular symptoms by compression of the brachial plexus and/or subclavian vessels, most often involving the medial aspect of the arm.…”

“…Patients complain of pain, decreased shoulder motion and brachialgia which comes as a complex of neurovascular symptoms by compression of the brachial plexus and/or subclavian vessels, most often involving the medial aspect of the arm. Several factors predispose to a nonunion according to the literature: open fractures, segmental comminution, shortening > 2 cm, operative treatment, refractures, and insufficient length of immobilization [4,5,8].…”

Evaluation of minimally invasive fixation with ESIN in the management of displaced mid-shaft clavicle fractures: a case series with minimum of 2 years follow-up

“…Plating osteo-synthesis has been shown to provide better stability but requires opening up of fracture site. [16][17][18][19][20] Intramedullary pinning with 3.2 mm Steinmann pin, K-wires or locked pins like Rockwood pin is also being advocated by certain groups. [8][9][10] With such pins fractures can be reduced and fixed in completely closed manner and results are also good, but there is significant problem of implant breakage, nonunion and intra-thoracic injury due to medial migration of nail.…”