From the Guidelines
Surgery is the recommended treatment for a non-union clavicle fracture, as it provides higher union rates and better early patient-reported outcomes compared to non-surgical treatment. The American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures 1 suggests that surgical treatment of displaced midshaft clavicle fractures in adult patients is associated with higher union rates and better early patient-reported outcomes than nonsurgical treatment.
Treatment Options
- Surgical treatment: Open reduction and internal fixation (ORIF) is the most common procedure, which involves stabilizing the fracture with plates and screws, often combined with bone grafting to stimulate healing.
- Non-surgical treatment: Options include electrical stimulation, ultrasound therapy, or a longer period of immobilization with a sling or figure-of-eight brace, but these approaches have lower success rates for established non-unions.
Considerations
- Patient's age, activity level, degree of displacement, and presence of symptoms like pain or functional limitation should be considered when choosing between surgical and non-surgical treatment.
- Surgery is generally more successful at achieving union and may provide better functional outcomes, especially for active individuals with displaced fractures 1.
- Pain management during recovery may include NSAIDs like ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily), and physical therapy is crucial after treatment to restore range of motion and strength.
Recommendation
Surgical treatment is the preferred option for non-union clavicle fractures, as it provides the best chance of achieving union and improving functional outcomes, according to the most recent and highest quality studies 1.
From the Research
Treatment Options for Non-Union Clavicle Fracture
The treatment options for a non-union clavicle fracture that has not healed include:
- Nonsurgical management
- Salvage procedures
- Reconstructive procedures 2 Reconstructive procedures aim to obtain union and restore the clavicle to its normal length. Fixation methods described range from external fixation to plate and screw osteosynthesis 2.
Surgical Interventions
Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle include:
- Open reduction and internal fixation with plate and screw osteosynthesis
- Intramedullary pin fixation
- Use of bone grafts 3, 4, 5 Open reduction and internal fixation with plate and screw osteosynthesis is a preferred method for obtaining union and restoring the clavicle to its normal length 2. The use of bone grafts can also be effective in managing painful nonunion 3.
Comparison of Surgical Methods
Comparisons of different surgical methods have shown that:
- Plating has faster time to union and lower reoperation rates than intramedullary pin fixation 4
- Bone graft use has lower rates of delayed union but substantially higher rates of complications and reoperations 4
- Low-contact dynamic compression plates are associated with better upper-limb function and reduced incidence of implant-associated symptoms compared to standard dynamic compression plates 5, 6
Considerations for Surgical Intervention
Surgery could be considered at 3 months post-injury in cases of symptomatic non-united clavicle fracture, and plating results in reliable outcomes 4. Adjuvant bone grafting requires further study to determine its value and risk/benefit ratio 4.