Clavicle non-union - Lucy Dennell 7/11/2002

Background

Definition – At least 16/52 post injury or earlier if major displacement + absence of callus. “a fracture that is not going to unite without surgical intervention”

Incidence 2% (3-5%)

S+S pain , Neuro vascular compromise

Aetiology, high energy,open#, closed # Rx surgically, separation of fragments by > 2cm, refracture


Almost all literature reports on plating with very few comparative studies.

Plating

Author Davids PH et al, Amsterdam , NL

Title Operative treatment for delayed union and non union of midshaft clavicular factures: AO reconstruction plate fixation and early mobilisation

Reference The Journal of Trauma: Injury, Infection and Critical Care 40(6) June

1996, 985-986

Summary 14 pts, mean # to surgery time was 24/12, immobilized w sling for 1/52 only then began early active motion. All united, one infection. All pts asymptomatic after 10 weeks

Critique Really a case series over 15 years. AO recon plate easier to shape + lower profile, yet strong enough to with stand early active motion

Boyer MI JBJS (Br) Vol 79 –B (2) 1997 301-303

Atrophic non union of the clavicle: Treatment by compression plate, lag screw fixation and bone graft.
7 pts, excision of the non union and shortening of clavicle by mean of 1.5 cm, no functional or cosmetic consequences.
All recommend bone graft whether ic or chips from non union

Plating vs im nailing

Author Wu CC et al, Chang Gung , Taiwan

Title Treatment of Clavicular aseptic non union:Comparison of Plating and im nailing techniques

Reference The Journal of Trauma: Injury, Infection and Critical Care 45(3) Sept 98; 512-6

Summary 29 pts, fu for min 1 year, median 3 years. 11 plated/18 im Steinmann pin or threaded Knowles pins. Both groups united by 4/12, plating 81.8% solid union, im 88.9%. Claim this as the only comparative study in the literature. Conclude that on clinical and theoretical grounds im nail superior than plating except in osteoporotic bone



Please log in to view the content of this page.
If you are having problems logging in, please refer to the login help page.


© 2011 Orthoteers.co.uk Website by Regency Medical Marketing 
Biomet supporting orthoteersThe British Orthopedic Association supporting OrthoteersOrthoteers is a non-profit educational resource. Click here for more details
Acromio-clavicular joint injuries -...
Anterior Shoulder Dislocation - Dus...
Anterior Shoulder Instability - Dav...
Clavicle Fractures - Dushan Atkinso...
Clavicle non-union - Lucy Dennell 7...
Displaced Proximal Humeral Fracture...
Frozen Shoulder - Alistair Jepson ...
Neer's paper: Proximal Humerus Frac...
Proximal Humerus Fractures ORIF or ...
Rotator Cuff Full Thickness Tears -...
Rotator Cuff Imaging - Ian McDermot...
Rotator Cuff Nonoperative Managemen...
Rotator Cuff Partial Thickness Tear...
Rotator Cuff Repair: Open vs Arthro...
Rotator Cuff Surgery: Outcomes - CC...
Shoulder Arthroplasty: The Glenoid ...
Shoulder Surface Arthroplasty and C...
OWLS British Orthopaedic Association supports Orthoteers
Orthoteers Junior Orthoteers Orthopaedic Biomechanics Orthopaedic World Literature Society Educational Resources Image Gallery About Orthoteers Orthoteers Members search
Hide Menu