Corrective Osteotomy for Symptomatic Clavicle Malunion Using Patient-specific Osteotomy and Reduction Guides

Abstract

Midshaft clavicular fractures are often treated nonoperatively with good reported clinical outcome in a majority of patients. However, malunion with shortening of the affected clavicle is not uncommon. Shortening of the clavicle has been shown to affect shoulder strength and kinematics with alteration of scapular position. Whereas the exact clinical impact of these factors is unknown, the deformity may lead to cosmetic and functional impairment as for example pain with weight-bearing on the shoulder girdle. Other reported complications of clavicular malunion include thoracic outlet syndrome, subclavicular vein thrombosis, and axillary plexus compression. Corrective osteotomy has therefore been recommended for symptomatic clavicular malunions, generally using plain x-rays for planning the necessary elongation. Particularly in malunited multifragmentary fractures it may be difficult to exactly determine the plane of osteotomy intraoperatively to restore the precise anatomic shape of the clavicle. We present a technique for corrective osteotomy using preoperative computer planning and 3-dimensional printed patient-specific intraoperative osteotomy and reduction guides based on the healthy contralateral clavicle.

Multiplane osteotomy of the clavicle for symptomatic malunion: a case report of augmentation of healing with bone morphogenetic protein-2

“…[7][8][9] Although there are associated risk factors for nonunion, predictive factors associated with clavicular malunions are poorly defined. 10,11 Recombinant human bone morphogenetic protein-2 (rhBMP-2) is an FDA-approved osteoinductive agent used in the treatment of open tibial fractures and anterior lumbar interbody fusion. 12,13 "Off-label" use of rhBMP-2 has been used to augment healing of delayed unions, nonunions, and situations associated with poor bone healing.…”

“…Symptomatic malunion may warrant corrective clavicular osteotomy and bone grafting to re-establish length and alignment to improve shoulder function 7–9. Although there are associated risk factors for nonunion, predictive factors associated with clavicular malunions are poorly defined 10,11…”

A simple surgical technique for correcting malunion after midshaft clavicle fracture

“…12 Recently, the treatment of clavicle malunion has gained renewed attention with the introduction of computer-assisted 3D reconstructions. [24][25][26][27] Patient-specific osteotomy guides are created using CT images of both clavicles. With this technique, the contralateral clavicle is used as a reference to recreate the affected clavicle.…”