Background: Total claviculectomy has been used for the treatment of
tumor, infection, nonunion, and vascular compromise. Given its limited
indications, few reports on the outcome after claviculectomy exist. The
purpose of the present study was to evaluate the function of the shoulder,
with use of a modern scoring system, after total claviculectomy.
Methods: A retrospective review of the records of six patients who
had undergone unilateral claviculectomy was performed after an average
duration of follow-up of 5.7 years. The indication for surgery had been an
infection at the site of a clavicular nonunion for three patients, nonunion
with subclavian vein compression for two, and pain after a failed medial
clavicular excision for one. The preoperative and postoperative evaluations
included testing of the range of motion, strength, and stability as well as
determination of the American Shoulder and Elbow Surgeons score on the basis
of a functional questionnaire.
Results: Range of motion was improved slightly or unchanged
following claviculectomy. The mean American Shoulder and Elbow Surgeons score
improved from 18 (range, 5 to 35) preoperatively to 88 (range, 75 to 95)
postoperatively. The mean pain level (with 0 indicating no pain and 10
indicating the worst pain) decreased from 9.5 preoperatively to 1.5
postoperatively. Postoperatively, strength testing showed improvement from
grade 4- (of 5) to 5 in all planes tested except extension (in which it
remained at grade 4). Patient satisfaction was high, with a mean of 9.0 on a
10-point scale. There were five complications, including one subclavian vein
laceration requiring vascular repair, two deep infections, and two superficial
Conclusions: Despite a high complication rate, the functional
outcomes following claviculectomy were good in this group of six patients.
Total claviculectomy may be a useful salvage procedure for clinical situations
in which the restoration of normal clavicular osseous anatomy is impossible.
Patients can expect acceptable pain relief and few or no deficits in
activities of daily living.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.