Clavicle Malunions: Surgical Treatment and Outcome—a Literature Review

Abstract

Background

Successful treatment of clavicle malunion represents a major challenge for orthopedic surgeons.

Questions/Purposes

The aim of this study was to provide an overview of surgical options for the treatment of clavicle malunions regarding their technical details and clinical results.

Methods

A comprehensive search of the literature was performed to retrieve articles and conference abstracts regarding the surgical treatment of clavicle malunions. A total of 1873 records were identified and 29 studies were included in the present review, with a total of 103 patients.

Results

The majority of the patients (77/103) were treated with an osteotomy and subsequent open reduction internal fixation (ORIF). The next most frequent management choice was debridement, excision, or removal of excess callus or bone (n = 19), but other techniques like resection of the clavicle (n = 5) or nerve exploration and decompression (n = 2) were also reported. The preferred method of fixation was plate fixation (n = 53) followed by pin fixation (n = 6). The complication rate was low, reported in less than 6% of patients.

Conclusion

All of the currently reported surgical techniques to manage symptomatic clavicle malunion have resulted in good clinical outcomes with a low complication rate. Considering biomechanical aspects, correction osteotomy followed by plate fixation seems to be the preferred method. Further studies are needed to compare the various surgical techniques and their specific outcomes in a prospective manner. Nevertheless, this review article can be used as an overview to help choose an optimal operative treatment for patients presenting with a clavicle malunion.

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Correspondence to Claudia Christine Sidler-Maier MD.

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Claudia C. Sidler-Maier, MD, and Nicolas J. Dedy, MD, PhD, have declared that they have no conflict of interest. Michael D. McKee, MD, FRCS (C), reports personal fees as a designer from Stryker and as a consultant from Zimmer, Acumed, and ITS, outside the work. In addition, Dr. McKee receives royalties from Stryker for a patent. Emil H. Schemitsch, MD, FRCS (C), reports grants and personal fees from Stryker, Smith & Nephew, and Zimmer; personal fees from Amgen, Bioventus, Acumed, Sanofi, and Pendopharm; and non-financial support from ITS, outside the work.

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Sidler-Maier, C.C., Dedy, N.J., Schemitsch, E.H. et al. Clavicle Malunions: Surgical Treatment and Outcome—a Literature Review. HSS Jrnl 14, 88–98 (2018). https://doi.org/10.1007/s11420-017-9583-3

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Keywords

  • clavicle malunion
  • corrective osteotomy clavicle
  • clavicle fracture
  • midshaft clavicle fracture
  • nonoperative treatment clavicle
  • complications clavicle fracture