Clavicle non-union: autologous bone graft is not a necessary augment to internal fixation

Most series of patients undergoing open reduction and internal fixation (ORIF) of clavicular non-union utilise distant autologous bone graft. We aimed to report the outcomes of a series of patients who had undergone ORIF for clavicular non-union without the use of distant bone graft. All patients undergoing ORIF of a clavicular nonunion were identified on the hospital database. Records were reviewed to determine basic demographics, operative findings, and radiological outcome. Patients were contacted and details about initial injury and treatment, and return to work and sport, were recorded. Disabilities of Arm, Shoulder and Hand (DASH) questionnaires for both operated and non-operated shoulders were completed. Fifteen patients with at least 6 months follow-up (average 12A) were identified. Their average age was 39 years. All patients were initially treated in a broad arm sling. All fractures were fixed with a pre-contoured locking plate and all went on to achieve clinical and radiological union. The average DASH score was 14.5 on the operated side and 4.2 on the contralateral side. All patients had returned to work and regular sport activities. One patient required plate removal due to local irritation. The results of this small series suggest that use of distant bone graft is not necessary when performing ORIF for symptomatic non-union of the clavicle with appropriate preparation of fracture ends and adequate fixation.