Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion

Up to 15% of all fractures involve the clavicle. Nonunion of the clavicle i s a rare complication after conservative treatment. It mainly presents as p ain at the fracture site and a limited range of motion of the shoulder. The purpose of this study is to define a certain type of fracture of the clavi cle that is predisposed to malunion and therefore should be treated surgica lly after failure of conservative treatment. Thirty-nine patients with dela yed or malunion of the clavicle were analyzed. There were 13 women and 26 m en. The average age of the male patients was 36.4 years (range 20-59 years) and of the female patients, 43.6 years (range 18-55 years). The mean follo wup period was 2.3 years (range 6 months to 4.2 years). All of them were tr eated surgically. There were 33 Allman I fractures and 6 Allman II. fractur es. Of the Allman I fractures, 30 (91%) were shortened by at least 2 cm. Al lman I fractures were treated using a reconstruction plate or a dynamic com pression plate in combination with bone grafting. The time of operation aft er fracture ranged from 6 weeks to 8.5 years (average 9.8 months). Pain at the fracture site was the leading symptom in all patients. At 6 months afte r the operation, 38 patients were free of pain with an unlimited range of m otion of the shoulder. One patient (2.6%) complained of a slight weakness o n the operated site. One fracture failed to unite (2.6%) and had to be repl ated. There were no refractures, infections, vessel or nerve lesions. To co nclude, in Allman I fractures with a shortening of more than 2 cm, we recom mend operative treatment in symptomatic patients if there are no signs of c allus formation after 6 weeks.