OPEN REDUCTION AND INTERNAL-FIXATION WITH BONE-GRAFTING OF CLAVICULARNONUNION

Background: Although clavicular fractures are common, nonunion of the clavicle is a rare complication, However, it can be disabling, present ing mainly with pain, limitation of shoulder movement, and/or compress ion of the brachial plexus, The technical difficulty in securing adequ ate skeletal stabilization and the unique anatomic features of the cla vicle pose a challenge for the orthopedic surgeon, Methods: Sixteen pa tients with symptomatic nonunion of the clavicle were studied, They we re nine men and seven women with a median age of 34 years (range, 15-5 2 years), The average follow-up was 12.9 months (range, 9-24 months), The nonunion was hypertrophic in 11 cases, atrophic in five cases, and showed pseudoarthrosis in one case, The primary indication for perfor ming the operation was pain in all cases, Five of the 16 cases had pre vious operations, All cases were treated with open reduction and inter nal fixation using a reconstruction plate or a dynamic compression pla te, Double plating was used in three cases, Autogenous bone grafting w as applied in 14 cases and corraline hydroxyapatite in one case, Resul ts: Fifteen of the 16 fractures eventually healed with complete resolu tion of the preoperative pain, except in two cases who had persistent mild pain, The hardware was removed after union in one case, One hardw are failure required revision and eventually went on to heal, Another hardware failure required removal because of pain, The pain subsided d espite the persistent nonunion, The same patient had hematoma at the s ite of the bone graft and continued to have pain until the last follow -up, Conclusion: Plating and bone grafting of the clavicle is an effec tive method of management of painful nonunion, and it has minimal comp lications.