Excision of symptomatic spinous process nonunion in adolescent athletes

While clay-shoveler's fractures in athletes are usually treated conservatively with rest, activity modification, and return to activities when symptoms abate, nonunion of these fractures can occur, given the ligamentous attachments and muscular forces acting on the fracture fragment. Surgical treatment for recalcitrant symptomatic nonunions in adolescent athletes has not been described in the literature. We examined the medical records and radiographs of adolescent athletes who presented with persistent symptoms related to a T1 spinous process nonunion at our institution. Three adolescent athletes were identified who underwent surgical excision of a nonunited ossicle after a T1 spinous process fracture and failure of conservative treatment. All patients had complete pain relief and were able to return to sports after surgical excision. There were no surgical complications. Persistent pain after a clay-shoveler's fracture in athletes has been described in the literature. This is the first case series describing surgical excision of the nonunited ossicle in athletes unable to return to play because of persistent disabling pain at the nonunion site. Excision should be considered if patients experience persistent pain after this injury, with expectation of complete resolution of symptoms after surgery.