Infected nonunion of the clavicle

10.1055/b-0034-86377

Infected nonunion of the clavicle

René K Marti

Case description

A 30-year-old woman presented with an infected defect nonunion of the clavicular midshaft after internal plate fixation.

Indication

Any infected nonunion has to be treated. As a first step, the infection has to be eliminated. The second step is the treatment of the nonunion.

Preoperative planning

Debridement and external fixation is the method of choice to start the treatment of infected defect nonunions. Classical external fixator devices are difficult to apply, bulky and uncomfortable, and furthermore an esthetic problem at the clavicle. The use of a DCP 3.5 as external fixator is an elegant stabilization method. The screws can be placed in all directions, but the screw heads have to be stabilized with a nut and a washer on the opposite side of the plate. An alternative is the use of a locking compression plate.

Equipment

Dynamic compression plate (DCP) 3.5 or reconstruction plate 3.5
Locking compression plates (LCPs) as alternative
Different sizes of curettes

(Size of system, instruments, and implants may vary according to anatomy.)

Patient preparation and positioning

The patient is placed in a beach-chair position.

A single dose of 2nd generation cephalosporin should be administered as a prophylactic antibiotic.

Surgical approach

As a first step, the initial implant is removed, then careful debridement of infected soft tissues and necrotic bone, including infected screw holes using small curettes, must be performed. For a successful infection treatment the whole nonunion area should be bleeding.

Reduction and fixation

A reconstruction plate 3.5 is bent and twisted according to the shape of the clavicle. Lengthening and reduction of the nonunited clavicle with two reduction forceps is performed. One screw is placed on both ends of the clavicle locked with nut and washer.

Further reduction is still possible; the additional two screws on each side of the clavicle can be fixed in any desired direction, providing optimal hold and stability. No screws are inserted within the infected area. Drainage and subcutaneous wound closure by a one-layer adaptation of the skin is performed. The open wound may be treated if necessary.