Lateral clavicular nonunion with torn coracoclavicular ligaments

10.1055/b-0034-86374

Lateral clavicular nonunion with torn coracoclavicular ligaments

René K Marti

Case description

A 29-year-old woman presented with a long-lasting lateral clavicular nonunion causing the same symptoms as a completely unstable acromioclavicular (AC) dislocation. She complained about pain, inability to perform overhead daily activities, and a bad cosmetic appearance.

Extreme superior dislocation of the nonunited medial clavicle. Small lateral fragment, both coracoclavicular ligaments are torn.

Indication

This type of unstable lateral clavicular nonunion causes a painful deformity with severely limited shoulder function. Successful stabilization of the nonunited clavicle will lead to a normal shape and function.

Preoperative planning

The distal fragment of the nonunion is extremely short, the bone atrophic and partially resorbed. Plate and screw fixation is difficult, internal fixation with a tension band is the author′s method of choice.

As a consequence of the completely torn ligaments the forces acting on the tension band wire will be extremely high. Ligament reconstruction and a cerclage wire around the tendon insertions at the coracoid process and the clavicle protect the tension band of the clavicle. Remnants of the ligaments may be sutured, otherwise a free tendon graft in a figure-of-eight is the solution (plantaris, toe extensor).