Midshaft clavicular nonunion



10.1055/b-0034-86372

Midshaft clavicular nonunion

Jesse B Jupiter

Case description


A 40-year-old woman sustained a closed midshaft clavicular fracture in a ski accident. She was treated conservatively with a sling. She presented 2 years postinjury with an unstable nonunion associated with shoulder dysfunction and signs and symptoms of thoracic outlet compression.



Indication


Nonunion of the midshaft of the clavicle can be associated with discomfort at the nonunion site, drooping and internal rotation of the ipsilateral shoulder, shoulder girdle dysfunction, and/or compression of the underlying neurovascular structures.

AP x-ray suggests a synovial pseudarthrosis with the nonunion ends rounded and a large gap present.
Nonunion of the midshaft.


Preoperative planning


Additional imaging can include a standing AP chest x-ray to assess clavicular length as well as 3-D CT scanning.



Equipment




  • Limited-contact dynamic compression plate (LC-DCP) or locking compression plate (LCP) 3.5



  • Small distractor



  • Drill with oscillating attachment


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



Patient preparation and positioning


Contralateral iliac crest is prepared for autogenous cancellous bone-graft harvesting. 2nd generation preoperative antibiotic prophylaxis is administered.

The patient is placed in a semiseated (“beach-chair”) position with arm freely mobile.


Surgical approach

A transverse incision parallel to the normal skin lines provides full access to the entire length of the clavicle.
Once the incision is made through the skin and subcutaneous tissues, care must be taken to identify and preserve the supraclavicular nerve branches.
An alternative approach favored by some surgeons involves a vertical (or “strap”) incision directly over the nonunion site. The author has found this less effective for nonunions that require more extensive exposure of the clavicle.

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Wave plate fixation of an atrophic midshaft clavicular nonunion Infected nonunion of the clavicle Anteroinferior plating of midshaft clavicular nonunions Lateral clavicular nonunion with torn coracoclavicular ligaments Lateral clavicular nonunion with intact coracoclavicular ligaments Nonunion of the clavicle—introduction

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Jul 12, 2020 | Posted by in ORTHOPEDIC | Comments Off on Midshaft clavicular nonunion

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