From the Guidelines
I strongly recommend surgical intervention for the nonunion of your displaced mid left clavicle fracture, as it provides the best chance for optimal recovery and minimizes the risk of long-term complications. The American Academy of Orthopaedic Surgeons clinical practice guideline summary on the treatment of clavicle fractures 1 suggests that surgical treatment of displaced clavicle fractures results in equivalent or improved short-term patient-reported outcomes and reduced rates of nonunion or symptomatic malunion when compared with nonsurgical treatment.
The procedure involves exposing the fracture site, removing any fibrous tissue between the bone fragments, realigning the bone ends, and securing them with a plate and screws. Recovery typically requires wearing a sling for 2-4 weeks after surgery, followed by progressive physical therapy focusing on range of motion exercises and gradual strengthening. Full recovery usually takes 3-6 months.
Surgery is recommended because nonunion of a displaced mid-clavicle fracture can lead to persistent pain, decreased shoulder function, and cosmetic deformity if left untreated. The clavicle plays a crucial role in shoulder mechanics, and restoring its normal length and alignment is important for optimal upper extremity function, especially for activities requiring overhead motion or heavy lifting. According to the guideline summary 1, 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.
Some key points to consider include:
- The importance of early intervention to minimize the risk of long-term complications
- The need for individualized treatment plans based on patient-specific factors, such as age, activity level, and overall health
- The potential benefits of surgical treatment, including faster recovery times and improved functional outcomes
- The potential risks and complications associated with surgical treatment, such as infection, nerve damage, and hardware failure.
Overall, the evidence suggests that surgical intervention is the best course of treatment for nonunion of a displaced mid left clavicle fracture, and I strongly recommend it based on the current guidelines and evidence 1.
From the Research
Nonunion of a Displaced Mid Left Clavicle Fracture
- The nonunion rate for clavicle fractures has been reported to be between 0.1% and 15% 2.
- Contributing factors to nonunion include severe initial trauma, marked initial displacement and shortening, soft tissue interposition, primary open reduction and internal fixation, refracture, open fracture, polytrauma, and inadequate initial immobilization 2.
- A clavicular nonunion is rarely asymptomatic and often results in disability from pain at the site of nonunion, altered shoulder mechanics, or a compression lesion involving the underlying brachial plexus or vascular structures 2.
Treatment Options
- Treatment options for clavicle nonunion include nonsurgical management, salvage procedures, and reconstructive procedures 2.
- Open reduction and internal fixation with plates and screws and with intercalary tricorticocancellous grafts can be used to obtain union and restore the clavicle to its normal length 2.
- Plating and bone grafting of the clavicle is an effective method of management of painful nonunion, with minimal complications 3.
- Single-plating fixation has been shown to have significantly faster union time, lower reoperation rate, and hardware removal rate than intramedullary pin fixation 4.
Surgical Intervention
- Surgical repair of clavicle fractures is being employed more frequently, although most fractures are still treated conservatively 4.
- Current treatments for clavicle nonunion include open reduction with internal fixation (ORIF) plating without bone graft, ORIF plating with bone graft, and intramedullary pin fixation 4.
- Bone graft use has been shown to have lower rates of delayed union but substantially higher rates of complications and reoperations 4.
- Surgery could be considered at 3 months post-injury in cases of symptomatic non-united clavicle fracture, and plating results in reliable outcomes 4.