Extension osteotomy in malunited clavicular fractures

Area of Science:

• Orthopedic Surgery
• Traumatology
• Upper Extremity Reconstruction

Background:

• Malunited clavicle fractures, though uncommon, can lead to significant disability including pain and shoulder dysfunction.
• Nonoperative treatment of clavicle fractures may result in malunion with shortening and associated ipsilateral glenohumeral dysfunction.
• This specific pattern of disability, distinct from neurovascular compromise, necessitates consideration for corrective surgical intervention.

Purpose of the Study:

• To evaluate the efficacy of extension osteotomy with autogenous bone grafting for correcting malunited clavicle fractures.
• To assess the impact of surgical correction on pain relief and shoulder function in patients with clavicle deformity.
• To report outcomes in a series of patients treated for malunited clavicle fractures causing functional impairment.

Main Methods:

• Retrospective case series of 4 patients with malunited clavicle fractures after nonoperative management.
• Preoperative radiographic assessment of clavicle shortening (0.9–2.2 cm).
• Surgical intervention involved extension osteotomy of the clavicle with iliac crest bone grafting, secured with plate and screws.

Main Results:

• All 4 patients experienced immediate pain relief post-osteotomy and deformity correction.
• Shoulder function demonstrated rapid improvement following surgery.
• Good functional outcomes, assessed by Constant-Murley and UCLA scales, were achieved in 3 out of 4 patients.
• Follow-up ranged from 6 weeks to 4 years.

Conclusions:

• Extension osteotomy combined with autogenous bone grafting is a viable surgical option for malunited clavicle fractures.
• This surgical approach effectively addresses pain and improves shoulder function in cases of clavicle deformity.
• Surgical correction should be considered for patients experiencing shoulder impairment secondary to malunited clavicle fractures.