title: Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion.
abstract: Up to 15% of all fractures involve the clavicle. Nonunion of the clavicle is a rare complication after conservative treatment. It mainly presents as pain 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 clavicle that is predisposed to malunion and therefore should be treated surgically after failure of conservative treatment. Thirty-nine patients with delayed or malunion of the clavicle were analyzed. There were 13 women and 26 men. 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 follow-up period was 2.3 years (range 6 months to 4.2 years). All of them were treated surgically. There were 33 Allman I fractures and 6 Allman II fractures. Of the Allman I fractures, 30 (91%) were shortened by at least 2 cm. Allman I fractures were treated using a reconstruction plate or a dynamic compression plate in combination with bone grafting. The time of operation after 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 after the operation, 38 patients were free of pain with an unlimited range of motion of the shoulder. One patient (2.6%) complained of a slight weakness on the operated site. One fracture failed to unite (2.6%) and had to be replated. There were no refractures, infections, vessel or nerve lesions. To conclude, in Allman I fractures with a shortening of more than 2 cm, we recommend operative treatment in symptomatic patients if there are no signs of callus formation after 6 weeks.
authors.affiliation: Chirurgische Klinik und Poliklinik, Berufsgenossenschaftliche Kliniken, Bergmannsheil, Bürkle-de-la-Camp Platz 1, 44789 Bochum, Germany. coupe356A@aol.com
authors.forename: M
authors.initials: M
authors.lastname: Wick
authors.forename: E J
authors.initials: EJ
authors.lastname: Müller
authors.forename: E
authors.initials: E
authors.lastname: Kollig
authors.forename: G
authors.initials: G
authors.lastname: Muhr
mesh_terms: D000293:Adolescent; D000328:Adult; D001860:Bone Plates; D002968:Clavicle / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal; D017102:Fracture Healing / Q000502:physiology; D005599:Fractures, Ununited / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012307:Risk Factors