Long-term outcomes of clavicular pseudoarthrosis therapy

Clavicular pseudoarthrosis is a rare condition, the management of which should not be underestimated because it requires re-operations and causes serious morbidity or even a lifelong handicap.

We reviewed a series of 13 patients with non-union of a clavicular fracture who underwent a surgical treatment from the year 1993 to 2002. Twelve fractures were a result of trauma and one was a result of osteomyelitis. Twelve non-unions were located in the middle third of the clavicle, while only one was in the lateral third. Seven non-unions were atrophic and six were hypertrophic. The average age of patients was 33 years (range: 14-52 years). Average post-operative follow-up time was 4.7 years (range: 1-11 years). In the study, we used intramedullar osteosynthesis such as Kirschner wire, different kinds of plates and screws, followed by autogeneous or heterogeneous bone grafting. Constant scoring system was used to evaluate mobility and strength of the upper extremity.

A single operation was adequate in seven cases; two operations were adequate in four cases and three operations were adequate in one case. Fractures healed properly in 11 cases, but in some cases mild-to-moderate symptoms still persisted post-operatively. The results of 13 patients who underwent various surgical procedures show that a reconstruction plate should be the first choice of osteosynthesis, followed by a dynamic-compression plate, and a semitubular plate should be the last choice. To conclude, with this kind of treatment of clavicular pseudoarthrosis, we achieved a high degree of patient satisfaction, as well as objective improvements in status reports.