Osteosynthesis of symptomatic nonunions of type II fractures of the distal clavicle using modified locking T-plate and bone grafting

Abstract

BACKGROUND: Type II distal clavicle fractures are generally unstable and hence prone to nonunion because of their specific biomechanical configuration. Nonunion of type II distal clavicle fractures sometimes poses a difficult problem causing pain and functional impairment of the shoulder girdle and upper limb. Therefore, operative treatment should be performed for symptomatic nonunions. However, there is very little information in the literature on nonunions of type II distal clavicle fractures to date.

METHODS: Ten consecutive patients with symptomatic nonunions of type II fractures of the distal clavicle were enrolled with a minimum follow-up of 24 months. The primary indication for surgery was pain on activity and osteosynthesis using modified oblique locking T-plate, and autogenous iliac bone graft without repair or reconstruction of coracoclavicular ligament was performed in all cases. Functional outcomes were assessed preoperatively and at final follow-up using Constant score, Modified Shoulder Rating Scale score, and the visual analog scale score.

RESULTS: In all cases, bony union was achieved at a mean of 14.7 weeks. No patients had pain during any of the activities at the latest follow-up but two, who complained of mild discomfort during strenuous activity. All but one patient regained full range of motion of the operated shoulder. Constant score improved from 76.3 to 92.3, and similarly, Modified Shoulder Rating Scale score increased from 11.3 to 18.2 after surgery. These functional assessments revealed seven excellent and three good outcomes with functional improvement. Preoperative visual analog scale score of a mean 3.8 decreased to 0.3 after the operation.

CONCLUSION: Osteosynthesis using modified oblique locking T-plate and autogenous iliac bone graft results in good to excellent outcomes with the functional improvement for symptomatic nonunions of type II fractures of the distal clavicle. Our method may be primarily considered an useful alternative for symptomatic nonunions of type II distal clavicle fractures, and bone grafting should be considered in all cases.