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http://dx.doi.org/10.5397/CiSE.2012.15.1.32

Intercalary Tricortical Iliac Bone Graft in the Surgical Treatment of Nonunion of Midshaft Clavicular Fractures  

Cho, Chul-Hyun (Department of Orthopedic Surgery, School of Medicine, Keimyung University)
Jang, Hyung-Gyu (Department of Orthopedic Surgery, School of Medicine, Keimyung University)
Publication Information
Clinics in Shoulder and Elbow / v.15, no.1, 2012 , pp. 32-36 More about this Journal
Abstract
Purpose: The purpose of this study was to evaluate the radiologic and clinical outcomes after intercalary tricortical iliac bone graft with plate fixation for the nonunion of midshaft clavicular fractures. Material and Methods: Between September 2007 and May 2011, 10 patients who were treated by the intercalary tricortical iliac bone graft, with plate fixation for clavicle nonunion, were studied. The mean follow-up period was 30.7 (12~57) months. After the sclerotic bone was excised to the bleeding cortical bone, we interposed the tricortical iliac bone to provide structural support and restore clavicle length, and then fixed the plate and screws. The radiologic outcomes on the serial plain radiographs and clinical outcomes, according to UCLA, ASES and Quick DASH scores, were analyzed. Results: Bony union was obtained in all cases (100%) and the average union time was 18.4 (14~24) weeks. The average respective UCLA and ASES scores improved from 16.7 and 52.1 preoperatively to 27.4 and 83.6 postoperatively (p<0.05). The average Quick DASH score was 40.5, at the final follow-up. Complications were 2 shoulder stiffness, and one case had removal of device and arthroscopic surgery at 11 months, postoperatively. There were no implant failure or infection. Conclusion: Intercalary tricortical iliac bone graft, with plate fixation for the nonunion of midshaft clavicular fractures, is a good option that can provide structural support and restore clavicle length, as well as high union rate.
Keywords
Clavicle; Nonunion; Bone graft; Tricortical; Intercalary;
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1 Ballmer FT, Lambert SM, Hertel R. Decortication and plate osteosynthesis for nonunion of the clavicle. J Shoulder Elbow Surg. 1998;7:581-5.   DOI   ScienceOn
2 Wick M, Muller EJ, Kollig E, Muhr G. Midshaft fractures of the clavicle with a shortening of more than 2 cm predispose to nonunion. Arch Orthop Trauma Surg. 2001;121:207-11.   DOI   ScienceOn
3 Huang HK, Chiang CC, Su YP, Feng CK, Chiu FY, Lu CL, Chen TH. Role of autologous bone graft in the surgical treatment of artophic nonunion of midshft clavicular fractures. Orthopedics. 2012;35:e197-201.
4 Erdmann D, Pu CM, Levin LS. Nonunion of the clavicle: a rare indication for vascularized free fibula transger. Plast Reconstr Surg. 2004;114:1859-63.   DOI   ScienceOn
5 Boyer MI, Axelrod TS. Atrophic nonunion of the clavicle: treatment by compression plate, lag-screw fixation and bone graft. J Bone Joint Surg Br. 1997;79:301-3.   DOI
6 Bradbury N, Hutchinson J, Hahn D, Colton CL. Clavicular nonunion. 31/32 healed after plate fixation and bone grafting. Acta Orthop Scand. 1996;37:367-70.
7 Chun CH, Kim SS, Sim DM, Lee BC, Choi IY. The clavicle nonunion treated by internal fixation and bone graft. J Korean Fracture Soc. 1993;6:312-317.   DOI
8 Demiralp B, Atesalp AS, Sehirlioglu A, Yurttas Y, Tasatan E. Preliminary results of the use of llizarov fixation in clavicular non-union. Arch Orthop Trauma Surg. 2006;126:401-5.   DOI
9 Ebraheim Na, Mekhail AO, Darwich M. Open reduction and internal fixation with bone grafting of clavicular nonunion. J Trauma. 1997;42:701-4.   DOI
10 Hoe-Hansen CE, Norlin R. Intramedullary cancellous screw fixation for nonunion of midshaft clavicular fractures. Acta Orthop Scand. 2003;74:361-4.   DOI
11 Ko SH, Cho SD, Park MS, et al. Internal fixation with plate and bone graft of mid-shaft clavicle nonunion. L Korean Shoulder Elbow Soc. 2005;8:19-22.   DOI   ScienceOn
12 Olsen BS, Vaesel MT, S􀝚jbjerg JO. Treatment of midshaft clavicular nonunion with plate fixation and autologous bone grafting. J Shoulder Elbow Surg. 1995;4:337-44.   DOI   ScienceOn
13 Van der Meijden OA, Gaskill TR, Millett PJ. Treatment of clavicle fractures: current concepts review. J Shoulder Elbow Surg. 2012;21:423-9.   DOI   ScienceOn
14 Wu CC, Shih CH, Chen WJ, Tai CL. Treatment of clavicular aseptic nonunion: comparison of plating and intramedullary nailing techniques. J Trauma. 1998;45: 512-6.   DOI   ScienceOn
15 Endrizzi DP, White RR, Babikian GM, Old AB. Nonunion of the clavicle treated with plate fixation: a review of forty-seven consecutive cases. J Shoulder Elbow Surg. 2008;17:951-3.   DOI   ScienceOn
16 Simpson NS, Jupiter JB. Clavicular Nonunion and Malunion: evaluation and surgical management. J Am Acad Orthop Surg. 1996;4:1-8.   DOI
17 Kabak S, Halici M, Tuncel M, Avsarogullari L, Karaoglu S. Treatment of midclavicular nonunion: comparison of dynamic compression plating and lowcontact dynamic compression plating techniques. J Shoulder Elbow Surg. 2004;13:396-403.   DOI   ScienceOn
18 Baker JF, Mullett H. Clavicle non-union: autologous bone graft is not a necessary augment to internal fixation. Acta Orthop Belg. 2010;76:725-9.
19 Khan SA, Shamshery P, Gupta V, Trikha V, Varshney MK, Kumar A. Locking compression plate in long standing clavicular nonunions with poor bone stock. J Trauma. 2008;64:439-41.   DOI   ScienceOn