Anteroinferior Plating of Midshaft Clavicle Nonunions and Fractures

Objective Anatomic reconstruction of clavicle with limited dissection and biomechanically optimal osteosynthesis. Anteroinferior plate placement to minimize patient's discomfort and need for implant removal. Indications Midshaft clavicle nonunions. Midshaft clavicle fractures. Clavicle malunions for which osteotomy is needed. Contraindications Infection. Compromised skin. Comorbidities causing unacceptable operative risks. Surgical Technique Expose anteroinferior aspect of the clavicle. Remove previous implants with minimal dissection. In atrophic nonunions, remove intervening tissue. Obtain cultures. Open medullary canal using drill. Contour standard or Locking Compression (LCP) 3.5-mm pelvic reconstruction plate (Synthes, Paoli, PA, USA) on anteroinferior aspect of clavicle. Use osteotome to petal/shingle the nonunion and add bone graft. In hypertrophic nonunions, bone graft is generally not needed but excess callus should be removed to prevent impingement on neurovascular structures. Postoperative Management Mitella for 10 days to protect wound healing. Start with early pendulum exercises. No active abduction or anteflexion of > 90 degrees or heavy lifting in first 6 weeks. Results From December 1993 to February 2007,52 patients (53 clavicles) were treated with anteroinferior plating of clavicle. There were 38 atrophic nonunions or delayed unions, three hypertrophic non unions, three infected non unions, six acute fractures, and one malunion. For two patients initial radiographs could not be located. Average age was 45 years. One patient was lost to follow-up prior to healing. The others were followed up after an average of 35 months. All had consolidation at an average of 3 months (range 2-7 months). Two patients underwent removal of a lag screw that was placed from superior to inferior, whereas three patients underwent plate removal.