Medial clavicle pseudarthrosis successfully treated with an inverted distal clavicle locking plate

Treatment of Symptomatic Medial Clavicle Nonunion with Intramedullary Tendon Allograft: A Case Report

CASE

A 67-year-old patient sustained a medial clavicle fracture (MCF) treated with open reduction and fixation with cerclage sutures. A year later, he presented with symptomatic nonunion and skin prominence, which was revised with an intramedullary tendon allograft fixation including the sternoclavicular joint. At 31 months after the procedure, the patient showed no pain or clinical instability.

CONCLUSION

MCF is an uncommon injury. Symptomatic nonunion after the failure of fixation is rarely described. Although the best way to treat this complication is debatable, revision fixation using an intramedullary tendon allograft can be a viable option in elderly patients.

Displaced medial clavicle fractures: a systematic review of outcomes after nonoperative and operative management

Background

Fractures of the medial clavicle are uncommon. There is no consensus regarding the optimal treatment of displaced medial clavicle fractures.

Methods

A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. PubMed, EMBASE, and the Cochrane Library were queried using the terms medial clavicle and fracture to identify all studies reporting on outcomes following either nonoperative or operative treatment of displaced medial clavicle fractures. Data extracted included patient demographics, fracture classification, surgical technique, patient-reported outcomes, physical, and radiographic findings. Study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS) scoring system.

Results

The analysis included 15 studies (mean MINORS score, 10 ± 1.5) with a total of 135 patients (85% male, mean age 47 ± 10.9 years [range, 15-87 years]). Five studies (39 patients) reported outcomes following nonoperative treatment. At a mean follow-up of 27 months, there were 5 (13%) symptomatic nonunions, 2 (5%) malunions, and 2 (5%) delayed unions. Eleven studies (96 patients) reported outcomes following surgical treatment with a mean follow-up of 23 months. There were no reported nonunions. Complications included plate prominence/ irritation (30%) and additional surgery was performed for plate removal (27%), fixation failure (3%), and wound débridement (1%).

Conclusion

There is limited, low-quality evidence in the literature to guide treatment of displaced medial clavicle fractures. The available data suggest that surgical treatment is associated with good functional outcomes and a lower risk of nonunion and malunion, compared to nonoperative treatment but plate irritation and further surgery to remove the plate was common.

Medial Clavicle Fracture Fixation Including the Sternum: A Case Report

CASE

A 29-year-old man presented with a displaced medial clavicle fracture. Surgical repair was performed using a precontoured plate designed for the contralateral distal clavicle, and medial fixation was accomplished at the sternum. The patient had no complications and demonstrated full strength and range of motion at the 8-month follow-up.

CONCLUSION

Medial clavicle fractures with a small medial fragment can be immobilized using a plate designed for the contralateral distal clavicle that crosses the sternoclavicular joint to obtain medial fixation in the sternum. This technique may provide a viable treatment modality for this unique fracture pattern.