Salvage Surgery for a Recalcitrant Clavicular Nonunion Using the Masquelet Technique: A Case Report.

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Bone Regeneration

Background:

• Complex midshaft clavicle fractures with multiple fragments and displacement pose significant treatment challenges.
• Previous surgical interventions, including anterior plate fixation and double-plate fixation with bone grafting, failed to achieve union in this case.
• Persistent nonunion led to chronic shoulder pain, functional limitation, and a desire for definitive treatment.

Observation:

• A 47-year-old male presented with a nonunion of a left clavicle fracture sustained in a motorcycle accident.
• Two prior surgical attempts, involving plate fixation and bone grafting, were unsuccessful due to hardware failure and graft resorption.
• The patient experienced persistent pain, shoulder droop, and functional impairment due to the nonunion.

Findings:

• The Masquelet technique, a two-stage reconstructive procedure, was employed as a salvage surgery.
• First stage involved placement of a cement spacer in the 3 cm bone defect and fixation with a locking plate.
• Second stage involved grafting cancellous bone and beta-tricalcium phosphate into the induced membrane.
• Bone union was achieved 4.5 years post-injury, with full functional recovery and pain resolution.

Implications:

• The Masquelet technique offers a viable solution for recalcitrant clavicle nonunions, even after multiple failed procedures.
• This technique demonstrates potential for reconstructing significant bone defects and promoting bone regeneration.
• Successful application of the Masquelet technique can lead to excellent functional outcomes and pain relief in complex orthopedic cases.