Mid-term Outcome Following Revision Surgery of Clavicular Non- and Malunion Using Anatomic Locking Compression Plate and Iliac Crest Bone Graft

Methods

Patients and follow-up

All patients who were treated for clavicular non- or malunion with a locking compression plate and an iliac crest bone graft between January 2010 and December 2014 were included in this retrospective study. The study protocol was approved by the local ethics committee (71/15 S).

The preoperative symptoms included pain (n=12), limited range of motion (n=2), pain when sleeping on the affected side (n=2), skin irritation caused by dislocated screws (n=1), feeling of weakness of the arm (n=1) and crepitation (n=1).

Standard radiographs of the affected clavicle (anterior-posterior path of rays perpendicular to radiographic cassette, anterior-posterior path of rays 30° tilted cephalad) were performed at the time of the initial presentation of the patient as well as during the routine follow-up examinations in our outpatient clinic. Preoperative planning included the performance of a magnetic resonance imaging (MRI) scan to estimate the non-vital parts of bone to be resected as well as the performance of a computed tomography (CT) scan of both clavicles to measure the original clavicle length to be able to adequately decide if a bone graft would be required. A tricortical iliac crest bone graft was used in all cases with bony defects larger than 15 mm due to the risk of abnormal shoulder biomechanics following clavicular shortening possibly resulting in pain, shoulder motion impairment and loss of strength.