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Functional Outcomes After Total Claviculectomy as a Salvage Procedure

A Series of Six Cases

¹ Shoulder Service, The Carrell Clinic, 9301 North Central Express-way, Suite 400, Dallas, TX 75231. E-mail address for S.G. Krishnan: skrishnan{at}wbcarrellclinic.com

Investigation performed at the Shoulder Service, The Carrell Clinic, Dallas, Texas

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Methods: A retrospective review of the records of six patients who had undergone unilateral claviculectomy was performed after an average duration of follow-up of 5.7 years. The indication for surgery had been an infection at the site of a clavicular nonunion for three patients, nonunion with subclavian vein compression for two, and pain after a failed medial clavicular excision for one. The preoperative and postoperative evaluations included testing of the range of motion, strength, and stability as well as determination of the American Shoulder and Elbow Surgeons score on the basis of a functional questionnaire.

Results: Range of motion was improved slightly or unchanged following claviculectomy. The mean American Shoulder and Elbow Surgeons score improved from 18 (range, 5 to 35) preoperatively to 88 (range, 75 to 95) postoperatively. The mean pain level (with 0 indicating no pain and 10 indicating the worst pain) decreased from 9.5 preoperatively to 1.5 postoperatively. Postoperatively, strength testing showed improvement from grade 4- (of 5) to 5 in all planes tested except extension (in which it remained at grade 4). Patient satisfaction was high, with a mean of 9.0 on a 10-point scale. There were five complications, including one subclavian vein laceration requiring vascular repair, two deep infections, and two superficial infections.

Conclusions: Despite a high complication rate, the functional outcomes following claviculectomy were good in this group of six patients. Total claviculectomy may be a useful salvage procedure for clinical situations in which the restoration of normal clavicular osseous anatomy is impossible. Patients can expect acceptable pain relief and few or no deficits in activities of daily living.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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