Complications and Outcomes After Surgical Intervention in Clavicular Nonunion: A Systematic Review
Thomas Yetter1, Jacob Harper1, Paul J Weatherby2
1John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, Texas.
JBJS Reviews
|February 1, 2023
Summary
Surgical repair of clavicle nonunion with plating offers faster healing and fewer reoperations than intramedullary pins. Early intervention (3 months) and plating yield reliable outcomes, while bone graft use requires further investigation.
Area of Science:
- Orthopedic surgery
- Trauma surgery
- Bone healing research
Background:
- Surgical repair of clavicle fractures is increasing, though most are treated conservatively.
- Clavicle nonunion can occur with both surgical and conservative treatments.
- Current surgical options include plating (with or without bone graft) and intramedullary fixation.
Approach:
- Systematic review and meta-analysis of 53 studies involving 1,258 clavicle nonunions.
- Subgroup analysis compared plating versus intramedullary fixation, bone graft use, and nonunion definition timing.
- Evaluated outcome, complication, and reoperation rates.
Key Points:
- Plating demonstrated faster union times (15.2 vs. 19.8 weeks) and lower reoperation rates (23% vs. 37%) compared to intramedullary fixation.
- Bone graft use was associated with lower delayed union rates but higher complication and reoperation rates.
- Defining nonunion at 3 months correlated with faster union times and fewer complications than a 6-month definition.
Conclusions:
- Plating is a reliable surgical option for clavicle nonunion, offering faster union and lower reoperation rates than intramedullary fixation.
- Early surgical consideration (3 months) for symptomatic nonunion may improve outcomes.
- The role and risk/benefit of adjuvant bone grafting require further research.
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