This study evaluated the results of 15 patients treated for symptoms related to a midshaft malunion of the clavicle treated with clavicular osteotomy. The mean time from fracture to presentation was 3 years (range, 1-15 years). Twelve of the 15 patients complained of weakness and pain exacerbated by repetitive or resistive activities as well as increased fatigue. Eleven of 15 patients had neurological symptoms consistent with thoracic outlet syndrome including numbness and parasthesis in the ulnar aspect of the hand exacerbated by overhead positioning. Thirteen of 15 patients reported an unacceptable appearance with drooping of the shoulder and/or discomfort with the use of backpacks. The mean degree of shortening radiographically was 2.9 cm (range, 1.6-4.0 cm). The operative intervention involved an osteotomy through the malunion site using osteotomes and a microsagittal saw to recreate the original fracture line and ultimately oppose two fresh osseous surfaces. No bone grafts were utilized. A 3.5mm LCDC plate with a minimum of 6 holes was used for stabilization. Fourteen of 15 patients were satisfied with the surgery. There was one persistent nonunion requiring revision open reduction internal fixation. The mean DASH score was improved from a preoperative value of 32 points to a postoperative value of 12 points (range, 0-45 points). Eight of the 12 patients with preoperative pain and weakness reported complete resolution of their symptoms and 4 stated they were decreased. Neurological symptoms were eliminated in 7 patients, decreased in 3, and unchanged in 1. The average range of shoulder motion did not change significantly following surgery and 2 patients elected to undergo plate removal because of local irritation.
This article further outlines orthopaedic, neurologic and aesthetic complaints attributable to clavicular nonunions that were significantly alleviated with surgical correction. There was a high union rate and overall patient satisfaction with minimal complications. One cannot make recommendations regarding the primary treatment of displaced clavicular fractures from this study. However, it does support the utility of osteotomy in the clinical setting of deformity and symptoms which could be related.
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J Bone Joint Surg