Management of Clavicle Nonunion and Malunion

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Clavicle fractures are common injuries and are reported to represent 2% to 5% of all adult fractures. More than two-thirds of these fractures involve the mid shaft of the clavicle, and as compared with medial-and lateral-third fractures, these are more likely to be displaced. It is traditionally suggested that clavicle fractures uniformly heal with nonsurgical management and result in good functional outcomes. More recent evidence suggests that specific subsets of patients may be at higher risk for nonunion, symptomatic malunion, or suboptimal functional outcomes.

A recent meta-analysis suggests that the incidence of clavicle nonunion after nonsurgical treatment is approximately 5.9%, but the incidence may be as high as 15% for some fracture subtypes. Moreover, nonsurgical treatment universally results in some degree of malunion; however, symptomatic malunion is fortunately less frequently observed. Both nonunion and malunion of the clavicle are capable of resulting in persistent pain and loss of shoulder function. Although surgical intervention is capable of improving these symptoms, patients are also reported to be at higher risk for complications. Surgical management of clavicle nonunion or malunion is often challenging but can result in union and improved shoulder function. The purpose of this article is to review operative techniques for, and outcomes of, clavicle nonunion and symptomatic malunion management.

Full Article: Management of Clavicle Nonunion and Malunion