title: Clavicular Refracture at the Site of Angular Malunion in Young Athletes.
abstract: OBJECTIVE
  The treatment of midshaft clavicle fractures has, in the last 2 decades, shifted markedly towards operative management. Prospective trials have defined accepted clinical and radiographic indications for the surgical management of clavicle fractures. This report documents 3 cases of clinically united angular malunion of the midshaft clavicle in young athletes that subsequently refractured to highlight angular deformity in the absence of displacement as a potential indication for surgical fixation.
  
  
  METHODS
  Case series.
  
  
  METHODS
  A level 1 trauma centre.
  
  
  METHODS
  Three young athletic patients with angular malunion of the midshaft clavicle who experienced refracture, requiring surgical fixation.
  
  
  METHODS
  Surgical fixation of midshaft clavicle fracture, as treatment for refracture after angular malunion.
  
  
  RESULTS
  All 3 patients required subsequent surgical fixation of their midshaft clavicle fracture, correcting the angular malunion and restoring shoulder function.
  
  
  CONCLUSIONS
  Midshaft clavicular fractures that malunite with significant angulation in the absence of displacement represent a risk for subsequent refracture. For this reason, angular deformity should be considered as a potential indication for surgical fixation in acute clavicular fractures.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Hand Program, Division of Plastic Surgery, Toronto Western Hospital, Toronto, ON, Canada; †Departments of Surgery and Mechanical and Materials Engineering, Western University, London, ON, Canada; and ‡Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, St. Michael's Hospital, the University of Toronto, Toronto, ON, Canada.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Furey
authors.forename: Radovan
authors.initials: R
authors.lastname: Zdero
authors.forename: Michael D
authors.initials: MD
authors.lastname: McKee
mesh_terms: D000293:Adolescent; D000328:Adult; D001265:Athletic Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D002968:Clavicle / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects* / Q000379:methods*; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D012008:Recurrence; D017211:Treatment Failure; D055815:Young Adult