The Journal of Bone and Joint Surgery, Vol 69, Issue 5 753-760, Copyright © 1987 by Journal of Bone and Joint Surgery, Inc
Non-union of the clavicle. Associated complications and surgical management
JB Jupiter and RD Leffert
Twenty-three patients who had a clavicular non-union were treated
operatively at the Massachusetts General Hospital from 1974 to 1985.
Twenty-one non-unions were the result of fracture and two, secondary to
osteotomy. Twenty non-unions were located in the middle third of the
clavicle, while three were in the lateral third. Radiographically, eighteen
non-unions were atrophic and three, hypertrophic. Two non-unions resembled
pseudarthrosis. Of the etiological factors that were reviewed the extent of
displacement of the original fracture was the most significant. Associated
complications of the non-union included limited mobility of the shoulder in
fourteen, neurological symptoms in eight, thoracic outlet syndrome in four,
and arterial ischemia in one. Of the nineteen patients who were treated to
obtain union, seventeen had a successful result at an average length of
follow-up of 23.8 months. In sixteen (93.7 per cent) of the seventeen
patients union was achieved by fixation with a plate; one patient required
two procedures. Ancillary bone graft was used in eighteen patients, with
three requiring a sculptured bicortical graft from the iliac crest to span
a defect. Of the four other patients three were treated with a partial
clavicular resection and one, with complete clavicectomy.
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