title: Functional outcome after open reduction and internal fixation for symptomatic delayed union and nonunion after fracture clavicle: A series of 31 cases.
abstract: BACKGROUND
  Non-union after clavicular fractures can cause significant disability due to pain, impaired function of the shoulder joint and limitations of certain activities, especially in high-demand patients.
  
  
  METHODS
  31 patients (21 males and 10 females) of symptomatic delayed union or nonunion were treated operatively using plate osteosynthesis with bone grafting where required between January 1994 to September 2005. Out of the 31 patients, 14 cases were of delayed union (no evidence of union > six wks) and 17 cases were of nonunion (no union > three months). Fracture of the lateral one-third and open fractures of the clavicle were not included in the study. Bone grafting was done in 23 patients. The outcome was assessed with the American Academy of Orthopedic Surgeons (AAOS) disabilities of the arm, shoulder and hand (DASH) questionnaire.
  
  
  RESULTS
  The patients were followed-up for an average of 13 months (range six months to four years). All fractures united with in three months Most of the patients had their DASH scores in the range of 10 to 20, the average being 14.7 in our series. Functionally, this was very much acceptable.
  
  
  CONCLUSIONS
  Open reduction and internal fixation with a plate in conjunction with an autogenous bone graft where required is a successful procedure with good outcome and most of the patients can return to a near normal level of function.
authors.affiliation: Mukhopadhaya Orthopedic Clinic and Research Centre, Saidpur Road, Saidpur, Patna - 800 004, India.
authors.forename: John
authors.initials: J
authors.lastname: Mukhopadhaya
authors.forename: Swastik
authors.initials: S
authors.lastname: Shivapuri