title: Use of the clavicular part of the pectoralis major in treatment of failed revision osteosynthesis of the clavicle.
abstract: BACKGROUND
  Symptomatic atrophic nonunion after multiple clavicle osteosynthesis can be difficult to treat. The aim of this study was to evaluate the results of a transfer of the clavicular part of the pectoralis major muscle as augmentation of osteosynthesis of these nonunions.
  
  
  METHODS
  A retrospective study included all patients who were treated between 2001 and 2010 (minimum 2-year follow-up). The indications for primary surgery, the number of operations, and the indication for a pectoralis major transfer were evaluated. Time of radiologic consolidation and postoperative complications were assessed. Clinical evaluation was performed with preoperative and postoperative satisfaction ratings and Constant-Murley scores.
  
  
  RESULTS
  The study included 11 patients. The indications for a primary osteosynthesis were acute displaced fractures (7), delayed union (2), nonunion (1), and malunion (1). On average, 3.7 procedures were performed (range, 2-6) before the tendon transfer. At revision, there were 2 patients with infection and 9 without infection. Of the 11 clavicles, 10 showed radiologic consolidation after a mean time of 10 weeks (6-20 weeks). The mean follow-up was 62 months (24-132 months). The mean Constant-Murley score increased from 37 (24-55) preoperatively to 59 (43-98), and the satisfaction rating increased from 2 (1-3) to 7 (2-10). Complications included nonunion (1), hardware removal (2), hardware irritation (4), and donor site pain (1).
  
  
  CONCLUSIONS
  The use of the clavicular part of the pectoralis major transfer as an augmentation in revision for symptomatic atrophic nonunion after multiple clavicle osteosynthesis showed good radiologic and acceptable clinical results.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium. Electronic address: Alexander.vantongel@uzgent.be.
authors.forename: Alexander
authors.initials: A
authors.lastname: Van Tongel
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium.
authors.forename: Lore
authors.initials: L
authors.lastname: Kegels
authors.affiliation: Department of Orthopaedics and Traumatology, Upper Limb Unit, AZ Sint-Jan AV Brugge-Oostende, Campus Brugge, Brugge, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Berghs
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium; Department of Orthopaedics and Traumatology, ZorgSaam Terneuzen, Terneuzen, The Netherlands.
authors.forename: Anne
authors.initials: A
authors.lastname: Karelse
authors.affiliation: Department of Orthopaedics and Traumatology, AZ Sint-Lucas Brugge, Brugge, Belgium.
authors.forename: Tom
authors.initials: T
authors.lastname: Van Isacker
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium.
authors.forename: Lieven
authors.initials: L
authors.lastname: De Wilde
mesh_terms: D000328:Adult; D000368:Aged; D002968:Clavicle / Q000293:injuries / Q000601:surgery*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010369:Pectoralis Muscles / Q000637:transplantation*; D012086:Reoperation; D012189:Retrospective Studies; D013709:Tendon Transfer / Q000379:methods*; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Clavicula; atrophic; failed osteosynthesis; nonunion; pectoralis major; soft tissue envelope