title: Late complications following clavicular fractures and their operative management.
abstract: We describe our experience of the operative treatment of sequelae from high-energy injuries of the clavicle. Surgery was performed on 17 patients who often had more than one indication. This included the following: painful non-union (nine patients), neurogenic thoracic outlet syndrome (TOS), hypertrophic non-union three patients, hypertrophic malunion five patients, bony spike two patients), vascular TOS (two patients) and brachial plexus neuroma (one patient). At clinical review, functional outcome was assessed by using a Constant score, a visual analogue pain score, return to work status and by patient subjective satisfaction rating. We performed 11 decompressions with callus excision, three simple neurolysis, eight fixations for non-union, one osteotomy and three excisions of bone spikes. Two patients required a further decompression procedure; one patient developed deep sepsis requiring sequestrectomy and two patients required removal of metalwork. At mean follow-up of 49 months the average Constant score was 64 (range 27-93). The mean pain score was 4. Ten patients returned to work at an average of 8 months. Five patients were completely asymptomatic, eight reported occasional paraesthesiae and three had significant cold intolerance. Patient satisfaction scores were 14% very satisfied, 50% satisfied, 14% unsatisfied and 22% very unsatisfied. High-energy clavicle injuries can cause significant morbidity due to non-union and TOS. Refractory symptoms can be improved by operative intervention with satisfactory functional outcome. However, the majority of patients experience some degree of residual symptoms.
authors.affiliation: Orthopaedic Department of Coventry, Warwickshire Hospital, Stoney Stanton Road, Coventry CV1 4FH, UK. ckitsis@doctors.org.uk
authors.forename: C K
authors.initials: CK
authors.lastname: Kitsis
authors.forename: A J
authors.initials: AJ
authors.lastname: Marino
authors.forename: S J
authors.initials: SJ
authors.lastname: Krikler
authors.forename: R
authors.initials: R
authors.lastname: Birch
mesh_terms: D000328:Adult; D020516:Brachial Plexus Neuropathies / Q000000981:diagnostic imaging / Q000601:surgery; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries*; D004739:England; D005260:Female; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009463:Neuroma / Q000000981:diagnostic imaging / Q000601:surgery; D010147:Pain Measurement; D017060:Patient Satisfaction; D011859:Radiography; D012784:Shoulder Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D013901:Thoracic Outlet Syndrome / Q000000981:diagnostic imaging / Q000601:surgery