Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion

Abstract

Up to 15% of all fractures involve the clavicle. Nonunion of the clavicle is a rare complication after conservative treatment. It mainly presents as pain at the fracture site and a limited range of motion of the shoulder. The purpose of this study is to define a certain type of fracture of the clavicle that is predisposed to malunion and therefore should be treated surgically after failure of conservative treatment. Thirty-nine patients with delayed or malunion of the clavicle were analyzed. There were 13 women and 26 men. The average age of the male patients was 36.4 years (range 20-59 years) and of the female patients, 43.6 years (range 18-55 years). The mean follow-up period was 2.3 years (range 6 months to 4.2 years). All of them were treated surgically. There were 33 Allman I fractures and 6 Allman II fractures. Of the Allman I fractures, 30 (91%) were shortened by at least 2 cm. Allman I fractures were treated using a reconstruction plate or a dynamic compression plate in combination with bone grafting. The time of operation after fracture ranged from 6 weeks to 8.5 years (average 9.8 months). Pain at the fracture site was the leading symptom in all patients. At 6 months after the operation, 38 patients were free of pain with an unlimited range of motion of the shoulder. One patient (2.6%) complained of a slight weakness on the operated site. One fracture failed to unite (2.6%) and had to be replated. There were no refractures, infections, vessel or nerve lesions. To conclude, in Allman I fractures with a shortening of more than 2 cm, we recommend operative treatment in symptomatic patients if there are no signs of callus formation after 6 weeks.

Primary Plating of Displaced Mid-shaft Clavicular Fractures

“…It has been shown that middle-third clavicle fractures with more than two cm of displacement or 15 mm of shortening are at increased risk for nonunion [7,15]. Thompson reviewed more than 100 middle-third clavicular nonunions reported in the literature and found that 90% of the original fractures had displacement greater than 100%, overriding more than one cm, or had severe comminution [11,16]. Although fractures with this much displacement are uncommon, accounting for 3% of all middle-third clavicle fractures, they warrant open reduction and internal fixation.…”

Clinical and Radiological Outcome after Surgical Treatment in Displaced Clavicular Midshaft Fracture

“…7) Displaced fracture of the clavicular midshaft shows a higher rate of delayed and nonunion than nondisplaced fracture patterns. [8][9][10][11][12][13][14] However, with the development of plates such as low-profile LCP, more stable fixation is possible and good results have been reported after surgical treatment in clavicle midshaft fracture. 4,5) 15) suggested leaving a plate in place for 12 to 18 months and placement of restrictions against contact sports for 2 to 3 months after plate removal.…”

Intramedullary Screw Fixation for Clavicle Shaft Fractures: Comparison of the Anterograde versus the Retrograde Technique

“…Another study by Zlowodzki et al 18) found that in 159 patients who received conservative treatment around 15.1% showed non-union. Wick et al 19) found that a high prevalence of diastasis was associated with patients who received conservative treatment for clavicle shaft fractures, which may have led to the decreased clinical outcome with a nonunion rate of 10% to 15%. Therefore, it is becoming more evident that conservative measures alone may not be sufficient for the treatment of clavicular fractures.…”