Reconstruction plate fixation with bone graft for mid-shaft clavicular non-union in semi-professional athletes

From 1993 to 1997, 22 semi-professional athletes (14 men and 8 women), aged 18-33 years (mountain bike racers, soccer players, handball players, swimmers, and short distance runners) with a non-union of the middle third of the clavicle were treated operatively by reconstruction plating and bone grafting. Fourteen clavicular non-unions were caused by falls. Eight non-unions were the result of a car, motorcycle, or bicycle accident. There were 19 atrophic and 3 hypertrophic non-unions. In all patients, initially a figure-of-eight strap or a sling was used for immobilization and no radiographic union was documented within 5 months. None of the athletes had gone back to their sports and all had pain and limitation of shoulder function. For open reduction and internal fixation, an AO 3.5-mm seven-hole reconstruction plate was used. The sclerotic bone ends were freshened and a cortical bone transplant or cancellous bone from the iliac crest (depending on the shortening of the clavicle) was packed around the fracture or between the reduced fracture ends. In all athletes, radiographic consolidation was achieved after an average of 14 weeks (range, 11-16 weeks) and the average increase in the Constant and Murley Score was from 79 points preoperatively to 97 points after surgery. No operative or postoperative complications occurred and all athletes returned to their sports.