Risk profile of patients developing nonunion of the clavicle and outcome of treatment: analysis of fifty five nonunions in seven hundred and twenty nine consecutive fractures

TY - JOUR

T1 - Risk profile of patients developing nonunion of the clavicle and outcome of treatment

T2 - analysis of fifty five nonunions in seven hundred and twenty nine consecutive fractures

AU - Ban, Ilija

AU - Troelsen, Anders

PY - 2016/3/1

Y1 - 2016/3/1

N2 - PURPOSE: The most common complication following treatment of a clavicle fracture is nonunion. Most nonunions are symptomatic and treatment is mostly operative. The aim of this study was to describe risk profiles of patients developing nonunion and what outcome is observed following operative treatment of clavicle nonunions.METHODS: In a consecutive series of 729 clavicle fractures we retrospectively identified 55 that developed nonunion (49 diaphysial and six lateral). All were treated operatively by reconstruction with (n = 28) or without (n = 27) autologous bone graft. Assessment of functionality and patient reported satisfaction and remission of symptoms was done a minimum of six months post-operatively by mail. Response rate was 60%.RESULTS: The overall nonunion rate was 7.5%. Nine nonunions were initially treated operatively. Risk factors associated with nonunion of our series was anatomic site, fracture complexity, female gender, smoking habits and initial treatment. A total of eight post-operative complications were found. Remission of symptoms was reported by 29 of the 33. Outright satisfaction with current shoulder condition was reported by 24. The overall median DASH was 8 (range 0-61). Following revision of the eight complications a total of 53 united successfully.CONCLUSION: Operative treatment of a clavicular nonunion seems to be effective as most patients unite and experience remission of symptoms. However, complications in close to 15% and lack of satisfaction of approximately 27% have to be acknowledged and thoroughly explained to the patient prior to treatment.

AB - PURPOSE: The most common complication following treatment of a clavicle fracture is nonunion. Most nonunions are symptomatic and treatment is mostly operative. The aim of this study was to describe risk profiles of patients developing nonunion and what outcome is observed following operative treatment of clavicle nonunions.METHODS: In a consecutive series of 729 clavicle fractures we retrospectively identified 55 that developed nonunion (49 diaphysial and six lateral). All were treated operatively by reconstruction with (n = 28) or without (n = 27) autologous bone graft. Assessment of functionality and patient reported satisfaction and remission of symptoms was done a minimum of six months post-operatively by mail. Response rate was 60%.RESULTS: The overall nonunion rate was 7.5%. Nine nonunions were initially treated operatively. Risk factors associated with nonunion of our series was anatomic site, fracture complexity, female gender, smoking habits and initial treatment. A total of eight post-operative complications were found. Remission of symptoms was reported by 29 of the 33. Outright satisfaction with current shoulder condition was reported by 24. The overall median DASH was 8 (range 0-61). Following revision of the eight complications a total of 53 united successfully.CONCLUSION: Operative treatment of a clavicular nonunion seems to be effective as most patients unite and experience remission of symptoms. However, complications in close to 15% and lack of satisfaction of approximately 27% have to be acknowledged and thoroughly explained to the patient prior to treatment.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Bone Transplantation

KW - Clavicle

KW - Female

KW - Fracture Fixation, Internal

KW - Fractures, Bone

KW - Fractures, Ununited

KW - Humans

KW - Male

KW - Middle Aged

KW - Postoperative Complications

KW - Reoperation

KW - Retrospective Studies

KW - Risk Assessment

KW - Risk Factors

KW - Treatment Outcome

KW - Young Adult

KW - Journal Article

U2 - 10.1007/s00264-016-3120-8

DO - 10.1007/s00264-016-3120-8

M3 - Journal article

C2 - 26847264

SN - 0341-2695

VL - 40

SP - 587

EP - 593

JO - International Orthopaedics

JF - International Orthopaedics

IS - 3

ER -