Nonunion of the Fractured Clavicle: Evaluation, Etiology, and Treatment

ABSTRACT: Although often viewed as benign injuries, clavicular fractures can lead to  complications, particularly nonunions. The nonunion rate has been reported to be between  0.1% and 15%. Contributing factors to nonunion include severe initial trauma, marked initial  displacement and shortening, soft tissue interposition, primary open reduction and internal  fixation, refracture, open fracture, polytrauma, and inadequate initial immobilization. A  clavicular nonunion is rarely asymptomatic and often results in disability from pain at the site  of nonunion, altered shoulder mechanics, or a compression lesion involving the underlying brachial plexus or vascular structures. Treatment options include nonsurgical management, salvage procedures, and reconstructive procedures. The present goal is to obtain union with reconstructive procedures. The fixation methods described range from external fixation to  plate and screw osteosynthesis. We prefer open reduction and internal fixation with plates and  screws and with intercalary tricorticocancellous grafts to obtain union and restore the clavicle  to its normal length.