Complications and Outcomes After Surgical Intervention in Clavicular Nonunion: A Systematic Review

Acute brachial plexopathy secondary to surgical management of an atrophic nonunion of a clavicle fracture

We report the case of a 28-year-old patient who developed acute transient brachial plexopathy secondary to surgical management of an atrophic clavicle nonunion. The treatment was conservative, with symptom resolution at 4 months after surgery. This is the first reported case with electromyographic and neuroconduction follow-up, demonstrating complete and spontaneous resolution of axonal damage. The limited number of cases reported in the scientific literature allows for exploring some underlying causes of the acute plexopathy depending on the nature of the non-union (hypertrophic or atrophic).

A novel treatment of clavicular nonunion: Combination with PRP, autologous bone grafting, and internal plate fixation

BACKGROUND

Nonunion is a major concern for orthopedic surgeons, particularly nonunion of the clavicle, which can cause severe pain, loss of full range of motion, poor sleep quality, and loss of strength in the affected individuals. Platelet-rich plasma (PRP), an important biological agent, is widely used in orthopedics.

OBJECTIVE

We used a combination of three techniques - the PRP technique, autologous bone grafting technique, and internal plate fixation technique - to ensure adequate internal fixation and enable a bone growth-supportive environment at the fracture site.

METHODS

The surgical approach was applied to a patient with clavicle nonunion.

RESULTS

Based on postoperative follow-up findings and intraoperative findings at the time of re-removal of the patient's implant, the prognosis at the fracture site was considered satisfactory.

CONCLUSION

We observed that the patient treated with this method had favorable clinical outcomes, and we recommend that this technique be used in patients with long-bone nonunion.

Evidence on treatment of clavicle fractures

Depending on the severity of the injury and the involvement of the soft tissue envelope, clavicle fractures can be treated operatively or non-operatively. In the past, displaced fractures of the clavicle shaft in adults have been treated non-operatively. However, the rate of nonunion following non-operative treatment seems to be higher than previously reported. In addition, publications reporting better functional outcomes following operative treatment are increasing. In recent years this has led to a paradigm shift towards an increase of operative fracture treatment. The aim of this review article was to summarize the currently available evidence on the treatment of clavicle fractures. Classifications, indications, and treatment options for different fracture patterns of the medial, midshaft, and lateral clavicles are presented and discussed.

Pseudoaneurysm of the subclavian artery as a delayed complication of a clavicle fracture

Vascular complications are relatively rare following surgical fixation of midshaft clavicle fractures. Here, we report a case of a woman in her 30s presenting 10 years after right clavicular open reduction and internal fixation with revision 6 years prior with sudden and rapidly progressive neck swelling. Physical examination revealed a soft pulsating mass in her right supraclavicular fossa. Ultrasound and CT angiography of the head and neck showed a pseudoaneurysm of her right subclavian artery with a surrounding haematoma. She was admitted to the vascular surgery team for endovascular repair with stenting. Postoperatively, she developed arterial thrombi requiring thrombectomy (twice) and is now on lifelong anticoagulation. It is crucial to be aware of complications that can develop in patients with a history of clavicular fracture managed non-operatively or operatively even years later and highlights the importance of risk and benefit discussions and counselling.