Treatment of Recalcitrant Medial Clavicle Non-union with Novel Dual Plating Technique

Abstract

Medial clavicle fracture are rare injuries associated with significant morbidity. Treated conservatively historically, operative management has been recommended to improve function and union rates. Optimal surgical fixation has not been described, particularly in revision cases following failed fixation. Previously described options include sternoclavicular fusion or partial claviculectomy. We describe a case of a 33-year-old female surgeon who had two failed surgeries treated with iliac crest tricortical grafting with dual plating using an anterior plate and an inverted distal clavicle plate. Postoperatively, she was instructed to use a bone stimulator and receive teriparatide treatment. At the 9 months follow up, patients pain and function improved, and she is back to working full time. Dual plating technique supplemented with bone stimulator use and teriparatide administration appears to be a good treatment option in the short-term.

Surgical repair of symptomatic medial clavicular fracture nonunion using a reversed distal clavicle plate: a report of 3 cases

“…Some authors suggested wire fixation, T-plate fixation, or advice for or against plating across the SC joint, all with varying outcomes. 2 , 3 , 5 , 13 , 19 Some noted drawbacks of plating across the SC joint are that the plate is subject to high torsion forces during shoulder motion and that another procedure is required to remove the hardware and restore motion. 2 , 13 , 19 However, locking plate fixation has produced good results when fixation over the sternum is a necessity, especially when compared to utilization of a nonlocking system.…”

“… 2 , 3 , 5 , 13 , 19 Some noted drawbacks of plating across the SC joint are that the plate is subject to high torsion forces during shoulder motion and that another procedure is required to remove the hardware and restore motion. 2 , 13 , 19 However, locking plate fixation has produced good results when fixation over the sternum is a necessity, especially when compared to utilization of a nonlocking system. 13 As described here, fixation across the SC joint with a reversed distal clavicle locking plate can be considered as a possible option when medial fracture fragment size precludes potential fixation in this area.…”

“…This has resulted in the utilization of different surgical approaches for symptomatic nonunion with varying outcomes, including stabilization with a palmaris longus graft, a dual plating technique, and multiple 2-staged approaches comprised of fixation and hardware removal. 1 , 2 , 4 , 16 …”