Instability after resection of a lateral clavicular nonunion

10.1055/b-0034-86375

Instability after resection of a lateral clavicular nonunion

René K Marti

Case description

After multiple interventions following a lateral clavicular fracture with torn coracoclavicular ligaments, a 42-year-old woman presented with a resected lateral clavicle. The remaining clavicle was unstable in all directions, upwards, anterior, and posterior. This dislocation can be compared with a Tossy III acromioclavicular (AC) dislocation.

Spontaneous upwards dislocation after lateral resection.

Example of coracoclavicular instablity. **a–b** The upwards dislocation of the clavicle is often asymptomatic. **c–d** Mainly the pathological anteroposterior motion of the clavicle is responsible for the clinical symptoms.

Indication

The partially resected clavicle causes a painfully unstable deformity with severely limited shoulder function. A bony reconstruction of the missing lateral clavicle would be difficult to achieve and would not eliminate the distressing coracoclavicular instability. Reconstruction of the coracoclavicular ligaments is the only possibility to get rid of the symptoms.

Preoperative planning

Only a double cerclage wire between clavicle and coracoid process is able to stabilize the clavicle in all directions. A single cerclage wire would still allow AP motion. For the reconstruction of the ligaments a free-tendon graft is necessary. For this type of surgery the author uses the plantaris tendon which can easily be found at the level of the knee and harvested with a special stripper with an incorporated scissor at the end of the instrument. If the plantaris muscle is no longer present the use of the extensor tendon of the fourth toe is a valid alternative.