TREATMENT OF CLAVICULAR ASEPTIC NONUNION - COMPARISON OF PLATING AND INTRAMEDULLARY NAILING TECHNIQUES

Objective: The aim of this retrospective study was to investigate and compare the effects of plating and intramedullary nailing in the treat ment of clavicular aseptic nonunion. Methods: Thirty-three consecutive patients with middle-third clavicular aseptic nonunions with previous nonoperative treatment were treated by plating (13 patients) and intr amedullary nailing (20 patients) with supplementary cancellous bone gr afting. The indications for such treatment were middle-third aseptic n onunions without previous operative treatment and with local pain or t enderness, deformity, or neurologic complaint. The choice of plating o r intramedullary nailing was according to the surgeon's individual pre ference. Results: Twenty-nine patients were followed for at least 1 ye ar (range, 1-7 years; median, 3 years; plating, 11; intramedullary nai ling, 18), The union rate was 81.8% (9 of 11) for plating and 88.9% (1 6 of 18) for intramedullary nailing (p = 0.35, Fisher's exact test). T he union period was 4.0 +/- 1.3 months for plating and 4.1 +/- 1.1 mon ths for intramedullary nailing (p = 0.80, unpaired Student's t test). The complication rate was 27.3% (3 of 11) for plating and 11.1% (2 of 18) for intramedullary nailing (p = 0.21, Fisher's exact test). There were no significant differences in other parameters. Conclusion: Intra medullary nailing may have a higher union rate with a lower complicati on rate than plating (p > 0.05), At least in common situations, it is not inferior to plating. Whenever possible, therefore, intramedullary nailing should be used preferentially to treat clavicular aseptic nonu nion without previous operative treatment. Nevertheless, both techniqu es have relatively higher nonunion rates in the treatment of clavicula r nonunion than in the treatment of other long-bone nonunions. Gentle handling of surrounding soft tissues to reduce bony fragments should b e strictly executed.