This retrospective review is of six patients that underwent a unilateral total claviculectomy over a three year period. The average age was 37 years with a predominant diagnosis of nonunion in five patients and persistent pain after a failed partial medial claviculectomy in the sixth patient. Three of these patients had symptoms consistent with subclavian stenosis. The mean American Shoulder and Elbow Surgeons score improved from 18 preoperatively to 88 postoperatively and the mean pain level decreased from 9.5 preoperatively to 1.5 postoperatively (0 to 10, worst). Postoperative strength improved from grade 4- to 5 in all planes, except extension which remained unchanged. Range of motion was unchanged, but was not significantly abnormal preoperatively. Patient satisfaction was high and all patients stated they would undergo this procedure again. However, there were five complications including one subclavian vein laceration repaired by a vascular surgeon, two deep infections requiring reoperation and two superficial infections treated with antibiotics alone.
In the present series, total claviculectomy appears to maintain range of motion and perishoulder girdle strength and provides durable pain relief and patient satisfaction. However, there was a high rate of complications including vascular injury and infection. The authors recommend immediate vascular surgery back up during the surgical resection. They also recommend prolonged antibiotics postoperatively until intraoperative culture specimens are finalized. They stress that the major contraindication to claviculectomy is trapezius dysfunction which can lead to severe functional loss, drooping of the shoulder and thoracic outlet type symptoms.
Clavicle, Claviculectomy, Shoulder, Excision
J. Bone and Joint Surgery