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

• Published in: Archives of orthopaedic and trauma surgery Vol. 121; no. 4; pp. 207 - 211
• Main Authors: WICK, M, MÜLLER, E. J, KOLLIG, E, MUHR, G
• Format: Journal Article
• Language: English
• Published: Berlin Springer 2001; Springer Nature B.V
• Subjects: Adolescent; Adult; Biological and medical sciences; Bone Plates; Clavicle - injuries; Clavicle - surgery; Female; Follow-Up Studies; Fracture Fixation, Internal; Fracture Healing - physiology; Fractures; Fractures, Ununited - diagnostic imaging; Fractures, Ununited - surgery; Humans; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Middle Aged; Pain; Radiography; Risk Factors; Traumas. Diseases due to physical agents; Human; Pseudoarthrosis; Prognosis; Pathophysiology; Indication; Orthopedic treatment; Diseases of the osteoarticular system; Shortening; Osteosynthesis; Fracture; Trauma; Diaphysis; Orthopedic surgery; Treatment; Clavicle; Complication; Thoracic girdle; Bone
• ISSN: 0936-8051; 1434-3916
• DOI: 10.1007/s004020000202

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.