Osteosynthesis with autologous dual bone graft for nonunion of midshaft clavicle fractures: clinical and radiological outcomes

Abstract

Purpose: This study evaluated the clinical and radiological results of plate osteosynthesis with autologous cortical and cancellous bone graft for nonunion of midshaft clavicle fracture. Methods: A retrospective review was performed for all patients who underwent surgery for midshaft clavicle nonunion at a Level I trauma center. Visual analog scales (VAS) for pain and Quick-DASH (Disabilities of Arm, Shoulder, and Hand) score were assessed. Bone union rate, change in length of affected clavicle, complications, and reoperation were determined. Risk factors were identified to determine the effect on the healing. Results: Thirty-four patients were included for analysis. All patients achieved solid bone union at mean 16 weeks (range 8-36) after surgery. The mean shortening of affected clavicle decreased significantly postoperatively (P < 0.001). There was significant improvement in both pain VAS and Quick-DASH score (P < 0.001). There was no wound complication, infection, or major neurovascular injury. Ten patients (29%) complained of plate irritation and underwent removal of implant without any subsequent adverse event. Multiple regression analysis demonstrated that high-energy trauma and previous surgery were the independent risk factors that significantly delayed time to union (P < 0.05). Conclusion: Osteosynthesis with autologous dual bone graft for nonunion of midshaft clavicle produced an excellent union rate with good clinical outcome and minimal complications.