The purpose of this study was to analyze the functional results of
corrective osteotomy of a malunited clavicular fracture in patients with
chronic pain, weak ness, neurologic symptoms, and dissatisfaction with the
appearance of the shoulder.
We identified fifteen patients (nine men and six women with a mean age of
thirty-seven years) who had a malunion following nonoperative treatment of a
displaced midshaft fracture of the clavicle. The mean time from the injury to
presentation was three years (range, one to fifteen years). Outcome scores
revealed major residual deficits. The mean amount of clavicular shortening was
2.9 cm (range, 1.6 to 4.0 cm). All patients underwent corrective osteotomy of
the malunion through the original fracture line and internal fixation.
At the time of follow-up, at a mean of twenty months (range, twelve to
forty-two months) post-operatively, the osteotomy site had united in fourteen
of the fifteen patients. All fourteen patients expressed satisfaction with the
result. The mean DASH (Disabilities of the Arm, Shoulder and Hand) score for
all fifteen patients improved from 32 points preoperatively to 12 points at
the time of follow-up (p = 0.001). The mean shortening of the clavicle
improved from 2.9 to 0.4 cm (p = 0.01). There was one nonunion, and two
patients had elective removal of the plate.
Malunion following clavicular fracture may be associated with orthopaedic,
neurologic, and cosmetic complications. In selected cases, corrective
osteotomy results in a high degree of patient satisfaction and improves
patient-based upper-extremity scores.