title: Plate fixation and bone grafting of distal clavicle nonunions: radiologic and functional outcomes.
abstract: BACKGROUND
  The optimal treatment for distal clavicle nonunions remains unknown. Small series have reported outcomes following distal fragment excision and various fixation techniques. We present the clinical, radiographic and functional outcomes after superior plating or double (superior and anteroinferior) plating in combination with bone grafting as treatment for distal clavicle nonunions.
  
  
  METHODS
  We collected demographic and radiographic data from a consecutive series of ten patients with symptomatic nonunion of the distal clavicle treated since 1998. Functional outcomes were assessed, as well as the visual analogue scale (VAS) score.
  
  
  RESULTS
  The mean clinical follow-up was 41.4 months (range of 12-158 months). The mean radiological follow-up was 30.6 months (range of 3-158 months). All nonunions healed as demonstrated by subsidence of clinical symptoms and radiographic criteria. The average time to union was 3.7 months (range of 2-8 months). The mean The Disabilities of the Arm, Shoulder and Hand (DASH) score was 11.9 (range of 0-62.5) and mean VAS score was 0.9 at follow-up.
  
  
  CONCLUSIONS
  This study illustrates good clinical, radiologic and functional outcomes in ten patients with distal clavicle nonunion treated with superior or double (superior and anteroinferior) plating in combination with bone grafting. Double-plating can be considered an alternative to superior plating offering better resistance against the pulling effect of the arm with the use of smaller fixation plates.
authors: Hospital for Special Surgery, 535 East 71st Street, New York, NY, 10021, USA. jordancarolinavilla@gmail.com.
authors: Jordan C
authors: JC
authors: Villa
authors: Hospital for Special Surgery, 535 East 71st Street, New York, NY, 10021, USA.
authors: Jelle P
authors: JP
authors: van der List
authors: Hospital for Special Surgery, 535 East 71st Street, New York, NY, 10021, USA.
authors: Elizabeth B
authors: EB
authors: Gausden
authors: Hospital for Special Surgery, 535 East 71st Street, New York, NY, 10021, USA.
authors: Dean G
authors: DG
authors: Lorich
authors: Hospital for Special Surgery, 535 East 71st Street, New York, NY, 10021, USA.
authors: David L
authors: DL
authors: Helfet
authors: Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors: Peter
authors: P
authors: Kloen
authors: Hospital for Special Surgery, 535 East 71st Street, New York, NY, 10021, USA.
authors: David S
authors: DS
authors: Wellman
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000379:methods*; D005599:Fractures, Ununited / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography / Q000379:methods*; D016059:Range of Motion, Articular / Q000502:physiology*; D012784:Shoulder Fractures / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult
keywords: Bone grafting; Distal clavicle nonunion; Outcomes; Plate fixation