Outcome after operative revision of clavicular nonunions: Clinical and radiographic results

Abstract

Background: Over the past decade, the treatment of midshaft clavicular fractures has increasingly shifted from conservative to operative therapy. The overall results seem to be better with surgery, although the problem of nonunion remains. The aim of this study was to report the functional results after operative revision of clavicular nonunions in two German level‑1 trauma centers. Methods: All patients who underwent surgery for clavicular nonunions during the past 10 years were invited for a structured clinical follow-up examination. The major functional outcome parameter was the age- and gender-adjusted Constant score. Additionally, radiographic fracture union was assessed with the available X‑rays. Complications such as wound site infections were also monitored. Results: In total, 31 patients were available for assessment. The mean follow-up rate was 69.7 ± 31.2 months. The mean age of the patients was 52.3 ± 15.2 years. The nonunion was classified as atrophic in 26 cases and hypertrophic in five. A total of 25 (80.6%) patients were treated with angular stable plating combined with autologous bone grafting from the iliac crest. The age- and gender-adjusted Constant score was significantly decreased compared with the noninjured side (82.2 ± 17.1 vs. 95.6 ± 10). Radiographic union was achieved in 30 of the 31 patients (96.8%). Complications with need for surgical revision were recorded for two patients. Conclusion: Surgery for clavicular nonunion is a safe and well-established procedure, which leads to radiographic union and good functional results for the majority of cases.