Complications and Outcomes After Surgical Intervention in Clavicular Nonunion: A Systematic Review.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSREV/A890). 2. J Shoulder Elbow Surg. 2021 Mar;30(3):679-684. doi: 10.1016/j.jse.2020.06.035. Epub 2020 Jul 12. Clavicle nonunion: plate and graft type do not affect healing rates-a single surgeon experience with 71 cases. Wiss DA(1), Garlich JM(2). Author information: (1)Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA. (2)Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA. Electronic address: John.Garlich@cshs.org. BACKGROUND: Clavicle nonunions often result after nonoperative treatment for the acute fracture. Those that require >1 surgical procedure in order for a nonunion to heal are termed recalcitrant. The aims of the present study were to (1) determine healing rates of clavicle nonunions after plate osteosynthesis using either a conventional or locked plate, (2) compare iliac crest bone graft vs. bone morphogenetic protein on nonunion healing, and (3) identify risk factors for the development of a recalcitrant nonunion. METHODS: We performed a retrospective analysis of a prospectively collected database of 78 clavicle nonunions treated with open reduction and plate fixation with or without graft augmentation by a single surgeon over 25 years. Seventy-one patients over the age of 18 with at least 12 months of follow-up comprised the study group. We analyzed healing rates after the index clavicle nonunion surgery comparing plate type and graft technique as well as identifying risk factors for developing a recalcitrant nonunion. RESULTS: A total of 62 patients (87.3%) healed after their index nonunion surgery at our institution. Three patients (4.2%) required additional surgery but healed, and 6 patients (8.5%) remain un-united; these 9 patients (12.7%) were defined as recalcitrant. There was no statistically significant difference in healing rates between plate type (P = .633) or type of bone graft (P = .157). There were no identifiable risk factors for the development of a recalcitrant nonunion. CONCLUSIONS: Plate fixation of clavicle nonunions remains a successful method of treatment. The type of plate or the method of bone graft did not produce different results. There were no demographic, patient, or injury characteristics associated with the development of a recalcitrant nonunion. Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved. DOI: 10.1016/j.jse.2020.06.035