title: Mid-term outcome following revision surgery of clavicular non- and malunion using anatomic locking compression plate and iliac crest bone graft.
abstract: Treatment of clavicular non- and malunion is still challenging. Current surgical procedures often result in frustrating functional outcome along with high-grade subjective impairment and increased rates of revision surgery. However, the combination of biological augmentation with vital bone graft and a biomechanically sufficient fixation system seems to be a promising concept of treatment.
  
  
  
  In this retrospective study, 14 patients with a mean age of 44 years (26-67 years) suffering from non-union (n = 11) and/or malunion (n = 3) of the clavicle were enrolled. All patients were surgically treated using an anatomical precontoured locking compression plate (LCP) and autologous iliac crest bone graft. Functional outcome was assessed using the age- and sex-specific relative Constant Score.
  
  
  
  Mean follow-up was 27 months (range 12-44 months). The relative Constant Score significantly improved from preoperative 61 ± 8 (43-72) to 82 ± 10 (65-100) points at the final follow-up examination (p < 0.05). All patients showed bony union radiographically. One patient presented with a re-fracture of the clavicle nearly 3 years after revision surgery and 5 weeks after implant removal. Secondary fractures at the donor site of the anterior superior iliac spine were recorded in two patients.
  
  
  
  Iliac crest bone graft and anatomic locking plate fixation allow for a safe and adequate stabilization and radiographical bony union in non- and malunions of the clavicle with a high degree of patient satisfaction. However, secondary fractures of the anterior superior iliac spine constitute relevant complications and the time of hardware removal should be considered carefully.
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, Munich, 81675, Germany. marc.beirer@mri.tum.de.
authors.forename: Marc
authors.initials: M
authors.lastname: Beirer
authors.affiliation: Clinic of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, Munich, 81675, Germany.
authors.forename: Ingo J
authors.initials: IJ
authors.lastname: Banke
authors.affiliation: Clinic of Orthopedics and Sports Orthopedics, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, Munich, 81675, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Harrasser
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, Munich, 81675, Germany.
authors.forename: Moritz
authors.initials: M
authors.lastname: Crönlein
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, Munich, 81675, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Pförringer
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, Munich, 81675, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Huber-Wagner
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, Munich, 81675, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Biberthaler
authors.affiliation: Department of Trauma Surgery, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr. 22, Munich, 81675, Germany.
authors.forename: Chlodwig
authors.initials: C
authors.lastname: Kirchhoff
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates / Q000639:trends*; D016025:Bone Transplantation / Q000379:methods; D002968:Clavicle / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007085:Ilium / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Clavicle; Complication; Iliac crest bone graft; Locking compression plate; Malunion; Non-union