title: Good reduction of paresthesia and pain after excision of excessive callus formation in patients with malunited clavicular fractures.
abstract: OBJECTIVE
  Sequelae following non-surgical treatment of clavicular fractures are not uncommon. The aim with this study was to describe results after excision of excessive callus in patients with late onset of paresthesia/numbness.
  
  
  METHODS
  Eight patients with hypertrophic callus after a malunited clavicular fracture were operated with removal of excessive callus and scar tissue, without stabilizing ostheosynthesis. The reason for surgery was paresthesia/numbness in the arm and hand. There was a delay between trauma and onset of symptoms on average 10 (6-18) months. Neurophysiology prior to surgery was normal in the patients tested. The mean age at trauma was 29 years and the mean time between trauma and operation was 66 months. A prerequisite for surgery was symptoms without recovery for at least 6 months.
  
  
  RESULTS
  At follow-up on average 20 months after surgery the paresthesia/numbness, pain at rest, pain during activity, headache and dizziness were significantly reduced or even gone in all patients. The improvement occurred almost immediately after surgery with no signs of recurrence during follow-up.
  
  
  CONCLUSIONS
  Removal of excessive callus and scar tissue after a malunited clavicular fracture can reduce or fully relieve disabling paresthesia and pain even if surgery is done several years after the fracture. Neurophysiological examination is normal due to lack of permanent neurologic damage and can not be used to confirm the symptoms.
authors.affiliation: Department of Orthopedics, Uppsala University Hospital, SE -751 85 Uppsala, Sweden. jan.nowak@skulderkliniken.se
authors.forename: J
authors.initials: J
authors.lastname: Nowak
authors.forename: E
authors.initials: E
authors.lastname: Stålberg
authors.forename: S
authors.initials: S
authors.lastname: Larsson
mesh_terms: D000328:Adult; D002146:Bony Callus / Q000473:pathology / Q000601:surgery*; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries*; D004576:Electromyography; D017759:Fractures, Malunited / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D006984:Hypertrophy; D006987:Hypesthesia / Q000209:etiology / Q000517:prevention & control; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000473:pathology*; D010292:Paresthesia / Q000209:etiology / Q000517:prevention & control*; D011859:Radiography